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心肌梗死后室壁瘤形成伴严重二尖瓣返流对左室附壁血栓形成的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第5期
页码:
641-642,649
栏目:
临床研究
出版日期:
2011-10-25

文章信息/Info

Title:
Effect of severe mitral regurgitation on left ventricular mural thrombus formation in patients with aneurysm after myocardial infarction
作者:
张治平; 刘成伟; 陈国洪; 苏 晞
武汉亚洲心脏病医院心脏监护室,湖北 武汉 430022
Author(s):
ZHANG Zhi-ping;  LIU Cheng-wei;  CHEN Guo-hong;  SU Xi
Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430022, Hubei, China
关键词:
心肌梗死; 室壁瘤; 二尖瓣返流; 血栓
Keywords:
myocardial infarction;  ventricular aneurysm;  mitral regurgitation;  thrombus
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的:探讨心肌梗死后室壁瘤形成伴严重二尖瓣返流对左室附壁血栓形成的影响。方法： 回顾性分析340例心肌梗死后室壁瘤形成患者的临床资料，根据是否并发严重二尖瓣返流分为严重二尖瓣返流组与非严重二尖瓣返流组，严重二尖瓣返流组84例，二尖瓣返流较轻或无返流256例，归为非严重二尖瓣返流组，比较两组左房直径、左室舒张末期直径、左室收缩末期直径、室间隔及左室后壁厚度、左室射血分数及左室附壁血栓发生率。结果： 分析结果显示，严重二尖瓣返流组的左室附壁血栓发生率明显低于非严重二尖瓣返流组(11% vs. 22%,P<0.05)。严重二尖瓣返流组的左房直径、左室舒张末期直径、左室收缩末期直径均大于非严重二尖瓣返流组（均P<0.01)。严重二尖瓣返流组的左室射血分数低于非严重二尖瓣返流组。左室舒张期室间隔厚度及后壁厚度两组无显著差异。结论： 心肌梗死后室壁瘤形成伴严重二尖瓣返流时可能有降低左室附壁血栓形成的作用。
Abstract:
AIM:To explore the effect of severe mitral regurgitation (MR) on left ventricular mural thrombus formation in patients with aneurysm after myocardial infarction (MI). METHODS: Clinical data of 340 consecutive patients with left ventricular aneurysm (LVA) after MI were retrospectively analyzed. Patients were divided into two groups according to the degree of mitral regurgitation diagnosed by echocardiography: 84 cases in severe MR group and 256 cases in nonsevere MR group. Mean left atrial (LA), LV end-diastolic and end-systolic diameter, thickness of the interventricular septum (IVS) and LV posterior wall (PW), LV ejection fraction (LVEF) and grade of the MR and left ventricular thrombus were compared between groups. RESULTS: The overall incidence of LV thrombus was lower in patients with severe MR than in patients without severe MR (11 vs. 22%, P<0.05). The mean LA and LV end-diastolic and end-systolic diameter were greater in patients with severe MR than in those without severe MR (P<0.01). The LVEF was lower in patients with severe MR than in patients without severe MR (P<0.01). No significant difference was found in the thickness of the IVS and LVPW between groups. CONCLUSION: Severe MR in patients with LVA after MI has some degree of preventive effect on LV mural thrombus formation. This relative risk reduction may be associated with an increased volumetric rate and diastolic volume overloading due to severe MR, which may overcome stagnation and a procoagulant state within the aneurysm.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2010-11-03.作者简介：张治平，主治医师Email:blyynk@sohu.com
更新日期/Last Update: 2011-11-03