摘要：
目的 分析陈旧性心肌梗死合并室壁运动异常患者最初5年超声心动图变化和主要心脏不良事件(MACE)发生情况.方法 收集2011年1月～2016年12月两次及多次住院治疗的66例陈旧性心肌梗死合并室壁运动异常患者最初5年的超声心动图及相关临床资料,分别分析连续3个时间段(A段病史≤1年、1年＜B段痛史≤3年、3年＜C段病史≤5年)患者超声心动图参数变化特征和MACE,评估心肌梗死后心功能改变、心室重构、MACE发生率,以及后二者之间的相互关联.结果 A、B、C时间段内患者左心房内径(LAd)、左心室舒张末期内径(LVDd)、左室射血分数(LVEF)、MACE发生率均有明显差异(P均＜0.05),LAd、LVDd逐渐增大,LVEF逐渐降低、MACE发生率逐步升高;并且3个时间段内LVDd与MACE均呈正相关(P均＜0.05).结论 陈旧性心肌梗死合并有室壁运动异常的患者在发病5年内发生不同程度的左心室重构,伴有左心室功能逐渐降低和主要心脏不良事件发生率逐步升高,并且左心室重构与患者预后相关.%Objective To retrospective explore ventricular remodeling (VR) and heart function by a ultrasonic cardiogram (UCG) testing,and the correlation between VR and major adverse cardiac events (MACEs) to patients with old myocardial infarction (OMI) and abnormal wall motion in first 5 years.Methods We made an observational retrospective fellow-up study involving a group of 66 patients hospitalized more than 2 times from January 2013 to December 2016.The general clinical data and characteristics of UCG collected to evaluate the heart function,VR and MACEs,as well as association between VR and MACEs.We divided the first 5 years history of OMI into 3 consecutive time segments,named A (≤lyear),B (＞1year,≤3years) and C(＞3years,≤5years),respectively.Results The left atrial dimension (LAd),left ventricular end-diastolic dimension(LVDd),left ventricular ejection fraction(LVEF),and the combined incidence of MACEs of patients were all significantly different among A,B and C segments (P＜0.05).LAd,LVDd and MACEs were gradually increased,while LVEF was decreased from A to C segments.The LVDd and MACEs had a positive correlation in A,B and C segments (r＝0.233,P＝0.032;r＝0.351,P＝0.022;r＝0.421,P＝0.016 respectively).Conclusions The left ventricular remodeling had occurred at different extents,and correlated with prognosis in most patients with OMI and abnormal wall motion in first 5 years,with left ventricular function be decreased,and MACEs risk be increased.
