Effects of reperfusion on left ventricular ejection fraction and volume after acute myocardial infarction.
抄録
The effects of reperfusion on left ventricular (LV) function and volume were studied in patients with evolving acute myocardial infarction (AMI). We analyzed the LV ejection fraction and volume in patients who had been admitted within 24 h of the onset of their first AMI with culprit lesion of #6, #7 and # 1 (American Heart Association classification). Sixty-five patients (Re group) received successful reperfusion therapy within 6 h after the AMI. The other 60 patients (Oc group), who were admitted from 6 to 24 h after the AMI, received conservative therapy. Patients with reobstruction of the culprit lesion after reperfusion therapy were excluded from the Re group. Patients with spontaneous recanalization following conservative therapy were excluded from the Oc group. The LV ejection fraction (LVEF), LV end-systolic volume index (LVESVI), and LV end-diastolic volume index (LVEDVI) were measured using a modified Dodge's formula by left ventriculography performed 4 weeks after the AMI. LVEF in the Re group was significantly greater than in the Oc group (57±12 vs 49±11%) (mean±SD, p<0.01). LVESVI in the Re group was significantly smaller than in the Oc group (30±13 vs 38±16ml/m2, p<0.01). Although LVEDVI was not significantly different between the 2 groups, in patients with a responsible coronary lesion of segment #6, LVEDVI in the Re group was significantly smaller than in the Oc group (67±14 vs 77±18 ml/m2, p<0.05). Although LVEF and LV volume correlated in both groups, the correlation was weak (r=0.40-0.42), suggesting that LV volume was not dependent solely on LV fuctional recovery. The incidence of ventricular aneurysm in the Re group was significantly lower than in the Oc group (15.4 vs 45.0%, p<0.01). Multi-variate analysis selected reperfusion of the responsible coronary artery as one of the factors significantly associated with a reduction of LVEDVI. LVESVI, an improvement of LVEF, and a decrease in the rate of aneurysm formation. In summary, our results indicated that reperfusion improved EF, reduced LV volume, and decreased the rate of aneurysm formation as compared to non-reperfusion, which suggests that reperfusion therapy is beneficial for both functional recovery and ventricular remodeling.
収録刊行物
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- JAPANESE CIRCULATION JOURNAL
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JAPANESE CIRCULATION JOURNAL 56 (8), 783-792, 1992
社団法人 日本循環器学会