急性心肌梗死后室壁瘤瘤体大小对心功能影响及与冠状动脉病变的关系

The influence of aneurysm size on left ventricular function and its relationship with coronary artery disease in patients with ventricular aneurysm after acute myocardial infarction

目的探讨急性心肌梗死后室壁瘤瘤体大小对左心室功能影响及与冠状动脉病变关系。方法选取2014-2017年遵义医科大学附属医院急性心肌梗死病人82例,其中合并室壁瘤38例为室壁瘤组,不合并室壁瘤病人44例为无室壁瘤组,比较两组间冠状动脉病变、左心室舒张末期内径(LVEDd)、左心室射血分数(LVEF)、N末端脑钠素前体(NT-proBNP)。采用Gensini积分,据总评分结果将室壁瘤组分为三个亚组,即轻度狭窄(<30分)、中度狭窄(30~60分)、重度狭窄(60分及以上),比较三组瘤基底部宽、瘤深、瘤体积;将室壁瘤组Gensini积分与瘤体大小行相关性分析。将室壁瘤组分为单支病变和多支病变两个亚组,比较两组瘤体大小。将瘤基底部宽、瘤深、瘤体积与LVEDd、LVEF、NT-proBNP做相关性分析。结果室壁瘤组与无室壁瘤组比较,室壁瘤组主要累及左前降支(LAD)(97.37%比79.55%,χ^2=4.499,P=0.034),室壁瘤组LVEDd较无室壁瘤组大[5.30(4.70,5.90)cm比4.90(4.60,5.50)cm,Z=-1.967,P<0.05],室壁瘤组LVEF较无室壁瘤组低[(39.00±8.69)%比(49.45±11.18)%,t=0.459,P<0.05]。室壁瘤大小与冠脉病变程度、冠脉病变支数无关(均P>0.05),与Gensini积分无相关性(均P>0.05)。瘤基底宽与LVEDd正相关(r=0.430,P<0.05),瘤基底宽、瘤体积与LVEF呈负相关(r=-0.425、-0.362,均P<0.05)。结论室壁瘤冠脉病变主要累及LAD。室壁瘤组心功能较无室壁瘤组差;室壁瘤大小与冠脉病变程度及病变支数均无关。瘤体累及范围越大、瘤体积越大,左心室越扩张,心功能越差。

Objective To investigate the influence of aneurysm size on left ventricular function and its relationship with coronary artery disease in patients with ventricular aneurysm after acute myocardial infarction.Methods A total of 82 patients with acute myocardial infarction in the Department of Cardiology,Affiliated Hospital of Zunyi Medical University from 2014 to 2017 were enrolled.Among them,38 patients with ventricular aneurysm were selected as the ventricular aneurysm group,and 44 patients with acute myocardial infarction but no ventricular aneurysm were selected as the control group.Coronary artery disease,left ventricular end-diastolic diameter(LVEDd),left ventricular ejection fraction(LVEF)and N-terminal pro-brain natriuretic peptide(NT-proBNP)were compared between the two groups.According to the total Gensini score,the ventricular aneurysm group was divided into three subgroups:mild stenosis(<30 points),moderate stenosis(30-60 points),and severe stenosis(60 points and above).The aneurysm base width,the aneurysm depth,and the aneurysm volume in the three subgroups were compared.Correlation analysis between Gensini score and aneurysm size was performed in patients with ventricular aneurysm.Patients with ventricular aneurysm were divided into two subgroups of single-vessel disease and multi-vessel disease,and the aneurysm size was compared between the two subgroups.Correlation analysis was performed between the aneurysm base width,the aneurysm depth,and the aneurysm volume and LVEDd,EF value and NT-proBNP.Results Compared with the non-ventricular aneurysm group,the ventricular aneurysm group mainly involved the left anterior descending artery(LAD)(97.37%vs.79.55%,χ^2=4.499,P=0.034),with larger LVEDd[5.30(4.70,5.90)cm vs.4.90(4.60,5.50)cm,Z=-1.967,P<0.05]and lower EF value[(39.00±8.69)%vs.(49.45±11.18)%,t=0.459,P<0.05].The size of the aneurysm was not related to the degree of coronary lesions and the number of lesions(P>0.05)and had no correlation with Gensini score(P>0.05).Aneurysm base width was positively correlated with LVEDd(r=0.430,P<0.05),while aneurysm base width and aneurysm volume were negatively correlated with LVEF(r=-0.425 and-0.362,respectively,P<0.05).Conclusion The coronary artery lesions mainly involve LAD in patients with ventricular aneurysm.The cardiac function of the ventricular aneurysm group is worse than that of the no ventricular aneurysm group.The size of the aneurysm is not related to the degree of coronary lesions and the number of lesions.The larger the ventricular aneurysm involves,the larger the ventricular aneurysm volume,the more the left ventricle expands and the worse the cardiac function.