<原著>心電図異常Q波消失を示す急性心筋梗塞の臨床的特徴

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Clinical features in patients who showed transient abnormal Q waves in acute myocardial infarction were analyzed. In 203 patients admitted to our hospital within 6 hrs after the onset of transmural infarction, serial electrocardiograms were obtained. Coronary angiography, left ventriculogram and other routine examinations were performed on admission and 3 months later. In 42 patients (20.7% : group A), abnormal Q wave was transient and disappeared within 1 month (71.5% of 42 patients) or later (28.5%). One hundred and fortyfive patients (71.4% : group B) showed persistent Q wave and 16 (7.9% : group C) showed the increase in number of Q waves. The coronary angiograms on admission revealed that there were many cases of spontaneous recanalization in group A (57.1%) compared with group B (31.8%). Occluded portion on the left anterior descending coronary artery was located more often in segment 7 and 8 (72%) than in segment 6 (28%) in group A, while it was more often detected in segment 6 (53.8%) than in segment 7 and 8 (46.1%) in group B, which suggests that group A has a smaller risk area. The left ventricular end-diastolic volume as well as the end-systolic one increased over to the chronic stage in group B, while they did not change in group A. This resulted in a reduction of global ejection fraction at chronic stage in group B and no reduction in group A. Regional ejection fraction at the infarcted portion improved significantly from 23.9±2.4 at acute stage to 33.6±3.8% at chronic stage (p<0.005) in group A, while it did not improve in group B. Wall motion index calculated by echocardiography and percent akinetic segment on left ventriculogram showed similar improvement over to the chronic stage with some difference between the groups A and B. We consider that the notable improvement in group A is attributable to the early recanalization of the infarct-related artery. These results indicate that patients of group A are characterized by a smaller risk area, a greater myocardial salvage due to early recanalization and a significant improvement in the wall motion of the infarcted portion. Since abnormal Q waves disappeared within one month in the majority of patients in group A, an electrically silent but viable state of the myocardium might be the possible mechanism of transient abnormal Q waves in acute myocardial infarction.
近畿大学の論文
1988-12-25

<原著>心電図異常Q波消失を示す急性心筋梗塞の臨床的特徴

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