右冠状动脉慢性闭塞合并陈旧下壁心肌梗死病人右心功能的评价

doi:10.3969/j.issn.1006-7795.2017.04.023

摘要/Abstract

摘要： 目的用二维超声心动图观察右冠状动脉（right coronary artery，RCA）慢性完全闭塞病变（chronic total occlusion，CTO）合并陈旧下壁心肌梗死病人右心功能的变化情况并探讨其临床意义。方法首都医科大学附属北京安贞医院2013年6月至2016年10月收治的28例RCA-CTO合并陈旧下壁心肌梗死病人，根据冠状动脉造影结果分为侧支循环良好组和侧支循环不良组，术前应用超声心动图测量2组右心室面积变化率（right ventricular fractional area change，RVFAC）、三尖瓣环收缩期位移（tricuspid annular plane systolic excursion，TAPSE）、心肌综合指数（myocardial performance index，MPI），多普勒超声心动图测量三尖瓣口舒张期血流速度（E、A峰值），组织多普勒（tissue Doppler imaging，TDI）测量三尖瓣环舒张期运动速度（e'及 a'值），比较2组临床特点、介入手术情况、术后心血管不良事件发生情况和平均住院时间。结果 2组比较，侧支循环不良组术前RVFAC、TAPSE较低，MPI、E/A比值及E/e'比值较高，提示侧支循环不良组较侧支循环良好组右室收缩及舒张功能均下降（P<0.05）；2组介入手术情况比较，侧支循环良好组术中严重心律失常发生0例，侧支循环不良组术中严重心律失常发生8例，占44.4%，2组差异有统计学意义（P<0.05）；术后发生严重心律失常在侧支循环良好组中有0例，侧支循环不良组有7例占38.9%，差异有统计学意义（P<0.05）；2组平均住院天数比较，侧支循环不良组住院时间较长（P<0.05）。结论 RCA-CTO合并陈旧下壁心肌梗死病人侧支循环形成不良较侧支循环形成良好者右心功能下降明显，术前二维超声心动图对此类病人右心功能的评估可以评价此类病人侧支循环形成良好与不良之间的差异，具有一定的临床意义。

关键词: 超声心动图, 右冠状动脉慢性闭塞, 陈旧下壁心肌梗死, 右心功能

Abstract: Objective To investigate the changes of right ventricular function in patients with right coronary artery (RCA) chronic total occlusion(CTO)combined with old inferior wall myocardial infarction(OIWMI) with two-dimensional echocardiography and to explore its clinical significance. Methods We studied 28 consecutive patients with RCA-CTO accompanied by OIWMI in Beijing Anzhen hospital, from June 2013 to October 2015. The patients were divided into the coronary collateral circulation(CCC) group and non-CCC group according to the results of coronary angiography. Echocardiography was performed in order to measure the right ventri cular fractional area change(RVFAC), tricuspid annular plane systolic excursion(TAPSE), myocardial performance index (MPI). Doppler echocardiography was used to measure tricuspid value diastolic blood flow velocity (E, A peak), this Dopplor measurement of tricuspid annulus diastolic velocity (e' and a'). The clinical features, interventional treatment, postoperative cardiovascular adverse events and average hospital stay were observed. Results Patients in the non-CCC group had lower TAPSE and RVFAC and a higher MPI, E/A ratio and E/e' ratio, it was suggested that the right ventricular systolic and diastolic function of non-CCC group were lower than those in the CCC group(P<0.05). Comparison of the two groups of interventional surgery, severe arrhythmia occurred in 0 cases in the CCC group and 8 cases(44.4%) in the non-CCC group, the difference was statistically significant(P<0.05). Postoperative severe arrhythmia occurred in the CCC group was 0 case and 7 cases(38.9%) in the non-CCC group, the difference was statistically significant(P<0.05). Comparison of the average number of hospital days in both groups, the average length of stay was longer in non-CCC group(P<0.05). Conclusion In patients of RCA-CTO combined with OIWMI, the poorly developed coronary collaterals have worse RV functions. Preoperative two-dimensional echocardiography can be used to evaluate the difference between the CCC group and non-CCC group and has a certain clinical significance.

Key words: echocardiography, right coronary artery chronic total occlusion(RCA-CTO), old inferior wall myocardial infarction(OIWMI), right ventricular function

中图分类号:

张琪, 陈振文. 右冠状动脉慢性闭塞合并陈旧下壁心肌梗死病人右心功能的评价[J]. 首都医科大学学报, 2017, 38(4): 609-614.

Zhang Qi, Chen Zhenwen. Evaluation of right ventricular function in patients with right coronary artery chronic total occlusion combined with old inferior wall myocardial infarction[J]. Journal of Capital Medical University, 2017, 38(4): 609-614.

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