급성 심근경색증후 시간경과에 따른 승모판 혈류의 변화

초록

Background: Although determination of Doppler echocardiographic transmitral inflow patterns (DETIP) is used as an indirect method assessing LV diastolic function, it is known that DETIP can be affected by certain hemodynamic variables. The aim of this investigation is to assess the serial changes of DETIP and to determine the relation of DETIP with clinical parameters such as initial left ventricular end-diastalic volume(LVEDV), ejection fraction(EF), Killip class and thrombolytic therapy in acute myocardial infarction(AMI) patients. Method: Four serial Doppler and 2-D echocardiographic studies were performed at 1 day. 1 week, 1 mouth and 3 months after development of AMI in 24 patients(M: F=19: 5, aged 58± 11 year, 15 anterior MI and 9 inferior MI) and 13 normal adults(aged 47±9 years) as reference group. On admission 14 patients were in Killip class I and 10 patients in class II. Thrombolytic therapy with IV urokinase were done in 11 patients. E velocity, A velocity, pressure half-time (PHT), isovolumic relaxation time(IVRT) were analyzed and LV systolic function was determined in apical 4 chamber view. Results: DETIP did not change until 1 month after development of AMI. However, E/A ratio was decreased, and PHT and IVRT were increased at 3 months after AMI. Doppler transmitral flow parameters were not related with Killip class and LV systolic function. Patients who received urokinase intravenously and who had greater initial LVEDV(>118 cm³) showed higher E/A ratio and shorter PHT and IVRT than those who did not. These findings indicate that changes in Doppler transmitral inflow pattern in AMI patients are not uniform over a period of 3 months and thrombolytic therapy causes favorable effect on Doppler transmitral flow parameters. Conclusion: Changes in Doppler transmitral inflow pattern may be variable over post-AMI period and this should be taken into account in evaluating LV diastolic function after AMІ. Thrombolytic therapy may improve LV diastolic function in AMI patients.

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