급성 심근 경색후 경색 관동맥의 잔존협착과 좌심실 확장과의 관계에 대한 연구

초록

Background Acute myocardial infarction produces alteration in the topography of both infarcted and non-infarcted region of ventricle. This remodelling process is reported to be influenced by several factors, such as infarct size, ventricular wall stress and patency of infarct-related artery. But little is known about the residual stenosis and its relation to ACE inhibitor in the change of left ventricular volume over time. Method To investigate the relation between clinical and angiographic factors, especially degree of residual stenosis, and ventricular dilatation after acute myocardial infarction, echocaardiography was done twice(7–15days, 1year) in 19 patients(male 11, female 8, mean age = 56 ± 10 yrs) of first acute anterior myocardial infarction with patent infarct-related artery. Measurement of left ventricular volume and ejection fraction was done by modified Simpson's method in apical four chamber view and left ventricle was divided into 16 segments and was analysed by 4 degree scoring method. The change of left ventricular volume and function was compared with clinical factors and angiographic findings. Results 1) There was no correlation between dilatation of left ventricle after acute myocardial infarction and history of hypertension or diabetes mellitus, use of thrombolytic agent in patients with patent infarct related coronary artery. 2) The increase of left ventricular volume after acute myocardial infarction was seen only in the group with more than 70% residual left anterior descending stenosis.(8.8% increase in group with >70% residual stenosis, 4.4% decrease in group with <70% residual stenosis, p=0.02) 3) The effect of ACE inhibitor in preventing left venticular dilatation after acute myocardial infarction was observed with marginal statistical significance in patients with more than 70% residual stenosis of infarct-related artery only(P=0.06. r= 0.542). Conclusion After myocardial infarction, the dilatation of left ventricular was more frequently observed in patients with more than 70% resideual stenosis of infarct-related artery. The beneficial effect of ACE inhibiotr in prevention of left ventricular dilatation was seen only in this group.

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