超声心动图检测陈旧性心肌梗死合并室壁运动异常患者5年随访结果分析
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摘要
目的分析陈旧性心肌梗死合并室壁运动异常患者最初5年超声心动图变化和主要心脏不良事件(MACE)发生情况。方法收集2011年1月~2016年12月两次及多次住院治疗的66例陈旧性心肌梗死合并室壁运动异常患者最初5年的超声心动图及相关临床资料,分别分析连续3个时间段(A段病史≤1年、1年 Objective To retrospective explore ventricular remodeling(VR)and heart function by a ultrasonic cardiogram(UCG)testing,and the correlation between VR and major adverse cardiac events(MACEs)to patients with old myocardial infarction(OMI)and abnormal wall motion in first 5 years.Methods We made an observational retrospective fellow-up study involving agroup of 66 patients hospitalized more than 2 times from January 2013 to December 2016.The general clinical data and characteristics of UCG collected to evaluate the heart function,VR and MACEs,as well as association between VR and MACEs.We divided the first 5 years history of OMI into 3 consecutive time segments,named A(≤1 year),B(>1 year,≤3 years)and C(>3 years,≤5 years),respectively.Results The left atrial dimension(LAd),left ventricular end-diastolic dimension(LVDd),left ventricular ejection fraction(LVEF),and the combined incidence of MACEs of patients were all significantly different among A,B and C segments(P<0.05).LAd,LVDd and MACEs were gradually increased,while LVEF was decreased from A to C segments.The LVDd and MACEs had a positive correlation in A,B and C segments(r=0.233,P=0.032;r=0.351,P=0.022;r=0.421,P=0.016 respectively).Conclusions The left ventricular remodeling had occurred at different extents,and correlated with prognosis in most patients with OMI and abnormal wall motion in first 5 years,with left ventricular function be decreased,and MACEs risk be increased.
引文
[1]郭雪微,马玉山,施一凡,等.冠心病不同类别与左心室重构及心脏功能[J].中国循环杂志,2003,18(2):108-110.
[2]张水旺,李丽,郭文玲,等.急性心肌梗死早期左室重构与发病时间[J].中华内科杂志,1999,38(zh):107-109.
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[4]BCijukli K,Schwencke C,Schofer J.Long-term major adverse cardiac and cerebrovascular events(MACCE)rate:Comparison of retrograde and antegrade recanalization of chronic total coronary occlusions[J].Wien Klin Wochenschr,2016,129(7-8):243-250.
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[6]彭军,鄢薇,韩丹.超声心动图评价慢性肺栓塞患者右心室重构的临床价值[J].中国实验诊断学,2017,21(3):411-413.
[7]刘爽,马春燕,李阳,等.左心室整体纵向应变预测急性心肌梗死患者经皮冠状动脉介入术后左心室重构[J].中国医学影像技术,2016,32(3):363-366.
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[12]朱桂平,雷达,曾智桓,等.不同时间窗延迟经皮冠状动脉介入治疗对急性ST段抬高型心肌梗死患者预后的影响[J].岭南心血管病杂志,2014,20(5):571-574.
[13]马礼坤,余华,黄向阳,等.急性前壁心肌梗死后梗死相关血管延迟开通对晚期左室重构的影响[J].中华心血管病杂志,2005,33(4):328-331.
[14]顾复生.醛固酮对心力衰竭的有害作用与醛固酮(受体)拮抗剂[J].中国循环杂志,2002,17(4):25-26.
[15]Huang B S,Leenen F H.The brain renin-angiotensin-aldosterone system:a major mechanism for sympathetic hyperactivity and left ventricular remodeling and dysfunction after myocardial infarction[J].Curr Heart Fail Rep,2009,6(2):81-88.
[16]NAHRENDORF ahrendor M,HU K,F raccarolloD,et al.Time course of right ventricular remodeling in rats with experimental myocardial infarction[J].Am J Physiol Heart Circ Physiol,2003,284(1):241-248.
[17]祝善俊.心力衰竭的进展(3)心室重构在心力衰竭发生和发展中的作用(续1)[J].中国循环杂志,2005,20(6):403-405.
[18]蹇晓东,王冬,李卉.ACEI及ARB治疗老年慢性充血性心力衰竭患者左心室重构的临床疗效[J].山东医药,2016,(5):48-50.
[19]郑哲岚,徐启彬,姚磊,等.多普勒组织声像图与二维超声心动图对冠心病诊断的对比研究[J].中国超声医学杂志,1998,(6):20-23.
[20]葛丽丽,李玉宏.斑点追踪技术对心肌梗死患者室壁运动的二维应变研究[J].中国医学影像学杂志,2012,20(6):455-458.
[2]张水旺,李丽,郭文玲,等.急性心肌梗死早期左室重构与发病时间[J].中华内科杂志,1999,38(zh):107-109.
[3]孙亚武,陆曙.急性心肌梗死后不同时点血浆NT-proBNP水平与左心室重构相关性的比较[J].临床心血管病杂志,2015,(12):1291-1292.
[4]BCijukli K,Schwencke C,Schofer J.Long-term major adverse cardiac and cerebrovascular events(MACCE)rate:Comparison of retrograde and antegrade recanalization of chronic total coronary occlusions[J].Wien Klin Wochenschr,2016,129(7-8):243-250.
[5]包明威,刘捷,黄从新,等.急性心肌梗死后左心室重构与室性心律失常的关系[J].临床内科杂志,2007,24(9):611-613.
[6]彭军,鄢薇,韩丹.超声心动图评价慢性肺栓塞患者右心室重构的临床价值[J].中国实验诊断学,2017,21(3):411-413.
[7]刘爽,马春燕,李阳,等.左心室整体纵向应变预测急性心肌梗死患者经皮冠状动脉介入术后左心室重构[J].中国医学影像技术,2016,32(3):363-366.
[8]闫峰,高大胜.斑点追踪成像在评估心肌梗死严重程度及其预后方面的应用[J].临床心血管病杂志,2017,(3):279-282.
[9]KimJ Y,Jeong M H,Choi Y W,et al.Temporal trends and inhospital outcomes of primary percutaneous coronary intervention in nonagenarians with ST-segment elevation myocardial infarction[J].Korean J Intern Med,2015,30(6):821-828.
[10]任文林,胡大一,赵远华,等.直接经皮腔内冠状动脉成形术及支架治疗对急性心肌梗死患者左心室重构和左心功能的影响—与尿激酶溶栓治疗对照[J].中国介入心脏病学杂志,2002,10(2):9-13.
[11]李科,刘俊明,黄文军,等.急性心肌梗死患者经皮冠状动脉介入治疗术后早期心室重构及心功能变化相关研究[J].中华实用诊断与治疗杂志,2012,26(7):656-658.
[12]朱桂平,雷达,曾智桓,等.不同时间窗延迟经皮冠状动脉介入治疗对急性ST段抬高型心肌梗死患者预后的影响[J].岭南心血管病杂志,2014,20(5):571-574.
[13]马礼坤,余华,黄向阳,等.急性前壁心肌梗死后梗死相关血管延迟开通对晚期左室重构的影响[J].中华心血管病杂志,2005,33(4):328-331.
[14]顾复生.醛固酮对心力衰竭的有害作用与醛固酮(受体)拮抗剂[J].中国循环杂志,2002,17(4):25-26.
[15]Huang B S,Leenen F H.The brain renin-angiotensin-aldosterone system:a major mechanism for sympathetic hyperactivity and left ventricular remodeling and dysfunction after myocardial infarction[J].Curr Heart Fail Rep,2009,6(2):81-88.
[16]NAHRENDORF ahrendor M,HU K,F raccarolloD,et al.Time course of right ventricular remodeling in rats with experimental myocardial infarction[J].Am J Physiol Heart Circ Physiol,2003,284(1):241-248.
[17]祝善俊.心力衰竭的进展(3)心室重构在心力衰竭发生和发展中的作用(续1)[J].中国循环杂志,2005,20(6):403-405.
[18]蹇晓东,王冬,李卉.ACEI及ARB治疗老年慢性充血性心力衰竭患者左心室重构的临床疗效[J].山东医药,2016,(5):48-50.
[19]郑哲岚,徐启彬,姚磊,等.多普勒组织声像图与二维超声心动图对冠心病诊断的对比研究[J].中国超声医学杂志,1998,(6):20-23.
[20]葛丽丽,李玉宏.斑点追踪技术对心肌梗死患者室壁运动的二维应变研究[J].中国医学影像学杂志,2012,20(6):455-458.