左心室舒张功能与急性心肌梗死患者左心室壁血栓形成的相关性  

Correlation between left ventricular diastolic function and left ventricular thrombosis in patients with acute myocardial infarction

作　　者：张胜豪 刘恒亮[2] 毛磊[2] 林炳辉 马超[3] ZHANG Sheng-hao;LIU Heng-liang;MAO Lei;LIN Bing-hui;MA Cao(Xinxiang Medical University Graduate School,Xinxiang,Henan 453000,China;Zhengzhou People′sHospital,Zhengzhou 450003,China;Southern Medical University,Guangzhou 510000,China)

机构地区：[1]新乡医学院,河南新乡453000 [2]郑州人民医院心内科,郑州450003 [3]南方医科大学,广州510000

出　　处：《岭南心血管病杂志》2019年第2期150-154,共5页South China Journal of Cardiovascular Diseases

基　　金：郑州市创新型科技人才队伍建设项目(项目编号:096SYJH33114)

摘　　要：目的评估左心室舒张功能障碍与急性心肌梗死(acute myocardial infarction,AMI)患者左心室血栓形成(left ventricular thrombus,LVT)的相关性。方法收集2016年1月至2018年1月郑州市人民医院AMI患者的病历资料以及超声心动图图像结果,并对于左心室舒张功能与LVT发生的相关性进行回顾性的分析。结果共纳入145例患者,其中9(6.21%)例患者出现LVT。出现LVT组和未出现LVT组患者间的一般临床资料比较,差异无统计学意义(P>0.05)。两组间左心室收缩末期内径(left ventricular end-systolic internal dimension,LVEIDs)(P=0.004)、左心室收缩末期容积(left ventricular end-systolic volume,LVESV)(P=0.034)、左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)(P=0.009)、左心室射血分数(left ventricular ejection fraction,LVEF)(P=0.004)、舒张功能指标(E/A)(P=0.024)、室壁瘤(P=0.024)以及舒张功能障碍≥Ⅱ级患者比例(P=0.033)比较,差异有统计学意义。其中LVEF<40%(P=0.045)、室壁瘤(P=0.003)以及舒张功能障碍分级是AMI患者发生LVT的危险因素。舒张功能障碍对于预测AMI后LVT的发生受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积为0.747(95%CI:0. 568～0.925,P=0. 013),当舒张功能障碍分级为Ⅱ级时,其诊断LVT的敏感性和特异性为51.2%和72.8%。结论在AMI患者中,舒张期功能障碍≥Ⅱ级、LVEF降低及室壁瘤的形成均与AMI患者LVT的发生有关。Objectives To assess the association between left ventricular diastolic dysfunction and left ventricular thrombosis(LVT)in patients with acute myocardial infarction(AMI).Methods The medical records of patients with AMI in Zhengzhou People′s Hospital from January 2016 to January 2018 and the results of echocardiographic images were collected and retrospectively analyzed for the correlation between left ventricular diastolic function and LVT.Results A total of 145 patients were enrolled,of whom 9(6.21%)had LVT.There was no significant difference in general clinical data between the presence of LVT group and the absence of LVT group.Left ventricular end-systolic internal dimension(LVEIDs)(P=0.004),left ventricular end-systolic volume(LVESV)(P=0.034),left ventricular end-diastolic volume(LVEDV)(P=0.009),left ventricular ejection fraction(LVEF)(P=0.004),diastolic function index(E/A)(P=0.024),ventricular aneurysm(P=0.024)and percentage of patients with diastolic dysfunction≥II were statistically different between the two groups.Among them,LVEF <40%(P=0.045),ventricular aneurysm(P= 0.003)and diastolic dysfunction grade(P<0.05)were risk factors for LVT in patients with AMI.Diastolic dysfunction predicts the occurrence of LVT after AMI with area under receiver operating characteristic curve(ROC)was 0.747 (95% CI:0.568-0.925,P=0.0013).When diastolic dysfunction was graded Ⅱ,it diagnosed the sensitivity and specificity of LVT were 51.2% and 72.8%.Conclusions Diastolic dysfunction ≥ grade Ⅱ,LVEF and ventricular aneurysm formation are associated with the occurrence of LVT in patients with AMI.

关 键 词：心肌梗死 心室舒张功能 心室血栓 室壁瘤 

分 类 号：R542.22[医药卫生—心血管疾病]