两维超声心动图评价冠心病心肌梗塞患者左室形态及其与心脏功能关系  

Quantitative Assessment of the Left Ventricular Shape and It's Relation to LV Function in Patients with the History of Myocardial Infarction Using Two dimensional Echocardiography

作　　者：陈立军[1] 李守平[1] 张技革[1] 杨浣宜[1] 刘汉英[1] 吴清玉[1] 

机构地区：[1]中国医学科学院阜外心血管病医院超声科

出　　处：《中华超声影像学杂志》1997年第3期152-155,共4页Chinese Journal of Ultrasonography

摘　　要：心肌梗塞（ＭＩ）后左室重构（ＬＶＲ）可导致左室局部和整体的变形及左室腔的扩大并进而影响左室功能。本文应用两维超声心动图定量评价冠心病（ＣＡＤ）患者ＭＩ后左室形态，并与左室造影ＥＦ比较，探讨心室变形对心功能的影响。病例组据左室造影ＥＦ值分为两组：Ⅰ组ＥＦ≥０．５５共１７人，其中７人有ＭＩ病史；Ⅱ组ＥＦ＜０．５５共２４人，均有ＭＩ病史；正常对照组２２人。结果Ⅱ组所有反映心脏形态的测值，除ＡＡ／ＢＡ无显著差异外，其它指标均明显高于正常对照组及Ⅰ组（Ｐ值＜０．０１），其中ＳＩ、Ｄ２／ＬＡ４Ｃ的增大，说明心脏失去正常椭圆形态趋于球形。ＡＡ／ＢＡ无显著差异说明心尖与心底呈对称弥漫性扩张。结论：ＣＡＤ心功能正常者（有或无ＭＩ），心脏形态无明显改变；ＭＩ后心功能减低患者左室整体扩张，趋于球形。这种球形改变与ＭＩ后ＬＶＲ密切相关。提示对ＭＩ患者应注意保护左室正常的椭圆形态，避免球形改变及心功能的恶化。Left ventricular remodeling (LVR) after myocardial infarction (MI) may result in ventricular chamber enlargement and regional as well as global distortion of the left ventricle (LV) shape, and may affect LV function enventually. The aim of our study was to quantitatively assess the LV shape in patents with the history of MI, and comparison with LV angiographic ejection fraction (EF), and to determine the effects of LV distortion on LV function. Patients were classified into two groups according to angiographic EF: group Ⅰ consisted of 17 patients with EF≥0.55, 7 patients had the history of MI; group Ⅱ consisted of 24 patients with EF<0.55, all had the history of MI; and there were 22 normal subjects as the control group. Results: All the LV shape descriptors in group Ⅱ showed statistically significant higher than that of normal control subjects and group Ⅰ patients, execpt apical area/basal ratio(P>0.05), the increase of spherical index (SI)and D2/LA4C indicating the loss of normal elliptical LV shape and towards a more spherical one. Apical area/basal area didn't change significantly showing that the dilation of the LV was symmetric and extensive, including base and apex of the LV. Conclusion: whether the patient had the history of MI or not, the shape of LV in patients with normal LV function didn't change significantly; in patients with reduced LV function, the LV chamber dilated entirely and had a more spherical LV. This spherical change of the LV associated with LVR closely which often occurred after MI. It implies the importance of maintaining the LV normal elliptical shape, avoiding the spherical change of the LV and deterioration of the LV function.

关 键 词：冠心病 心功能 超声心动描记术 

分 类 号：R541.4[医药卫生—心血管疾病]