急性心肌梗死高龄患者心肌灌注水平影响左室重构
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摘要
为了探讨高龄急性心肌梗死(acute myocardial infarction, AMI)患者心脏超声特点,分析左室重构(left ventricle remodel, LVR)与心肌灌注水平的相关性,本研究选取2016年2月至2017年10月在广西医科大学第一附属医院治疗的高龄AMI患者104例,根据患者年龄分为A组49例(60～79岁)和B组55例(≥80岁),比较两组心脏超声指标,采用声学造影积分指数(contrast score index, CSI)评估两组术后心肌灌注水平。结果表明,B组后下壁心肌梗死比例为27.27%,明显高于A组(p<0.05);B组和A组前壁、下壁、前壁+下壁心肌梗死比例差异无统计学意义(p>0.05);B组左心室射血分数(left ventricular ejection fraction, LVEF)为(45.29±12.14)%,明显低于A组(p<0.05),左心房内径和左心室内径分别为(46.10径和左心室) mm和(57.29径和左心室内) mm,明显高于A组(p<0.05);B组经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后6个月CSI为(0.68±0.20),明显低于A组(p<0.05);B组术后左心房内径和左心室内径分别为(50.01±8.10) mm和(64.10±7.02) mm,明显高于A组(p<0.05);左心室内径与CSI呈负相关(r=-0.312, p<0.05)。综上表明,≥80岁患者与60～79岁患者心脏超声特点有所差异,年龄超过80岁的患者心功能以及PCI术后心肌灌注水平较差;心肌灌注水平与左室重构有一定相关性。
In order to investigate the characteristics of echocardiography and the relationship between left ventricular remodeling(LVR) and myocardial perfusion in elderly patients with acute myocardial infarction(AMI). 104 elderly AMI patients who were treated in First Affiliated Hospital of Guangxi Medical University from February 2016 to October 2017 were selected in this study, according to the age of the patients were divided into A group(60～79 years old) 49 cases and B group 55 cases(≥80 years old), two groups of echocardiographic indexes were compared, and the two groups were treated with percutaneous coronary intervention(PCI), and the level of myocardial perfusion in two groups was evaluated by the contrast score index(CSI). Results showed that: The ratio of posterior inferior wall myocardial infarction in B group was 27.27%, which was significantly higher than that in group A(p<0.05);There were no significant difference in the ratio of anterior wall, inferior wall, anterior wall+lower wall myocardial infarction in B group and A group(p>0.05); The left ventricular ejection fraction(LVEF) in B group was(45.29±12.14)%, which was significantly lower than that in A group(p<0.05), and the left atrium diameter and left ventricular diameter were(46.10±9.11) mm and(57.29±10.03) mm, which were significantly higher than those in A group(p<0.05);The CSI in group B at 6 months after PCI was(0.68±0.20), which was significantly lower than that in A group(p<0.05);The left atrium diameter and left ventricular diameter of B group after operation were(50.01±8.10) mm and(64.10±7.02) mm, which was significantly higher than that in A group(p<0.05); The left ventricle diameter was negatively correlated with CSI(r=-0.312, p<0.05). All this suggests that: The echocardiographic features in patients with ≥80 year old and 60～79 years of age are difference, cardiac function and myocardial perfusion level after PCI in ≥80 year old patients is poor; there is a certain correlation between myocardial perfusion and left ventricular remodeling.
In order to investigate the characteristics of echocardiography and the relationship between left ventricular remodeling(LVR) and myocardial perfusion in elderly patients with acute myocardial infarction(AMI). 104 elderly AMI patients who were treated in First Affiliated Hospital of Guangxi Medical University from February 2016 to October 2017 were selected in this study, according to the age of the patients were divided into A group(60～79 years old) 49 cases and B group 55 cases(≥80 years old), two groups of echocardiographic indexes were compared, and the two groups were treated with percutaneous coronary intervention(PCI), and the level of myocardial perfusion in two groups was evaluated by the contrast score index(CSI). Results showed that: The ratio of posterior inferior wall myocardial infarction in B group was 27.27%, which was significantly higher than that in group A(p<0.05);There were no significant difference in the ratio of anterior wall, inferior wall, anterior wall+lower wall myocardial infarction in B group and A group(p>0.05); The left ventricular ejection fraction(LVEF) in B group was(45.29±12.14)%, which was significantly lower than that in A group(p<0.05), and the left atrium diameter and left ventricular diameter were(46.10±9.11) mm and(57.29±10.03) mm, which were significantly higher than those in A group(p<0.05);The CSI in group B at 6 months after PCI was(0.68±0.20), which was significantly lower than that in A group(p<0.05);The left atrium diameter and left ventricular diameter of B group after operation were(50.01±8.10) mm and(64.10±7.02) mm, which was significantly higher than that in A group(p<0.05); The left ventricle diameter was negatively correlated with CSI(r=-0.312, p<0.05). All this suggests that: The echocardiographic features in patients with ≥80 year old and 60～79 years of age are difference, cardiac function and myocardial perfusion level after PCI in ≥80 year old patients is poor; there is a certain correlation between myocardial perfusion and left ventricular remodeling.
引文
Cruz I.,Caldeira D.,Stuart B.,Cotrim C.,Joao I.,and Pereira H.2015,Complica?oes de enfarte do miocárdio:ecocardiograma para diagnóstico diferencial de sopro cardíaco,Rev.Port Cardiol.,34(12):781-783
Fu R.,Yang Y.J.,Dou K.F.,Yang J.G.,Gao X.J.,Xu H.Y.,Wu Y.,Li W.,and Wang Y.,2016,Age-related differences in the clinical symptoms and triggering factors among Chinese patients with acute myocardial infarction,Zhonghua Xinxueguanbing Zazhi(Chinese Journal of Cardiology),44(4):298-302(伏蕊,杨跃进,窦克非,杨进刚,高晓津,许海燕吴元,李卫,王杨,2016,中国不同年龄段急性心肌梗死患者临床症状和诱发因素的差异分析,中华心血管病杂志,44(4):298-302)
Gao X.J.,Yang J.G.,Yang Y.J.,Li W.,Xu G.Y.,Wu Y.,Yan R.H.,and Jin C.,2016,Age-related coronary risk factors in Chinese patients with acute myocardial infarction,Zhonghua Yixue Zazhi(National Medical Journal of China),96(40):3251-3256(高晓津,杨进刚,杨跃进,李卫,许海燕,吴元,严若华,金辰,2016,中国急性心肌梗死患者不同年龄组心血管危险因素分析,中华医学杂志,96(40):3251-3256)
Joyce E.,Leong D.P.,Hoogslag G.E.,van Herck P.L.,Debonnaire P.,Abate E.,Holman E.R.,Schalij M.J.,Bax J.J.,Delgado V.,and Marsan N.A.,2014,Left ventricular twist during dobutamine stress echocardiography after acute myocardial infarction:association with reverse remodeling,The International Journal of Cardiovascular Imaging,30(2):313-322
Kyt?V.,Sipil?J.,and Rautava P.,2014,Gender,age and risk of ST segment elevation myocardial infarction,Eur.J.Clin.Invest.,44(10):902-909
Yang Y.J.,Wang F.,Mo Z.,Wu Y.F.,Chen H.M.,Liu X.D.,and Lai Y.Q.,2017,Prediction of myocardial systolic function recovery with myocardial perfusion after primary percutaneous coronary intervention,Zhongguo Yixue Yingxiang Zazhi(Chinese Journal of Medical Imaging),25(5):377-382(杨亚娟,王飞,莫展,吴仰帆,陈火梅,刘晓丹,赖玉琼,2017,急诊经皮冠状动脉介入术后心肌灌注对心肌收缩功能恢复的预测价值,中国医学影像学杂志,25(5):377-382)
Fu R.,Yang Y.J.,Dou K.F.,Yang J.G.,Gao X.J.,Xu H.Y.,Wu Y.,Li W.,and Wang Y.,2016,Age-related differences in the clinical symptoms and triggering factors among Chinese patients with acute myocardial infarction,Zhonghua Xinxueguanbing Zazhi(Chinese Journal of Cardiology),44(4):298-302(伏蕊,杨跃进,窦克非,杨进刚,高晓津,许海燕吴元,李卫,王杨,2016,中国不同年龄段急性心肌梗死患者临床症状和诱发因素的差异分析,中华心血管病杂志,44(4):298-302)
Gao X.J.,Yang J.G.,Yang Y.J.,Li W.,Xu G.Y.,Wu Y.,Yan R.H.,and Jin C.,2016,Age-related coronary risk factors in Chinese patients with acute myocardial infarction,Zhonghua Yixue Zazhi(National Medical Journal of China),96(40):3251-3256(高晓津,杨进刚,杨跃进,李卫,许海燕,吴元,严若华,金辰,2016,中国急性心肌梗死患者不同年龄组心血管危险因素分析,中华医学杂志,96(40):3251-3256)
Joyce E.,Leong D.P.,Hoogslag G.E.,van Herck P.L.,Debonnaire P.,Abate E.,Holman E.R.,Schalij M.J.,Bax J.J.,Delgado V.,and Marsan N.A.,2014,Left ventricular twist during dobutamine stress echocardiography after acute myocardial infarction:association with reverse remodeling,The International Journal of Cardiovascular Imaging,30(2):313-322
Kyt?V.,Sipil?J.,and Rautava P.,2014,Gender,age and risk of ST segment elevation myocardial infarction,Eur.J.Clin.Invest.,44(10):902-909
Yang Y.J.,Wang F.,Mo Z.,Wu Y.F.,Chen H.M.,Liu X.D.,and Lai Y.Q.,2017,Prediction of myocardial systolic function recovery with myocardial perfusion after primary percutaneous coronary intervention,Zhongguo Yixue Yingxiang Zazhi(Chinese Journal of Medical Imaging),25(5):377-382(杨亚娟,王飞,莫展,吴仰帆,陈火梅,刘晓丹,赖玉琼,2017,急诊经皮冠状动脉介入术后心肌灌注对心肌收缩功能恢复的预测价值,中国医学影像学杂志,25(5):377-382)