Time Course of Left Ventricular Remodeling After Myocardial Infarction : A Two-Dimensional Echocardiographic Study
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概要
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In order to forecast the clinical course of acute myocardial infarction (MI), the time course of the functional changes of the left ventricular myocardium that result in remodeling was evaluated with two-dimensional echocardiography (2DE). The study group comprised 45 patients with anterior MI treated with successful percutaneous transluminal coronary angioplasty. 2DE studies were performed on days 1, 3, 7 and 14; months 1 and 3 and 1 year after MI, and the follwing parameters were recorded: (1) infarcted wall thickness, (2) traced length of the endocardium and of the epicardium on end-diastolic apical long axis images, and (3) wall motion score (total of asynergy scores of 16 segments of left ventricle (LV); normal: 0, hypokinesis: 1, akinesis: 2, dyskinesis: 3). According to the peak creatine kinase (CK) level, patients were classified into L group (CK≥8000U/L, n=16), M group (8000>CK≥4000, n=13) and S group (CK<4000, n=16). The following results were obtained. (1) There was progressive thinning of the infarcted myocardium up to 1 month after (1 day: 9.3±1.7, 14 days: 6.3±1.7 vs 1 month: 5.9±1.8 mm, p<0.05; vs 1year: 5.9±1.9 mm, NS). (2) Dilataration of the LV cavity occurredshortly after MI and continued up to 14 days (endocardium at 14 days, 176.8±13.6 vs 1 day: 164.1±11.4 mm, p<0.01, vs 1 year: 176.3±12.7 mm, NS). (3) The wall motion score improved repidly by 14 days, and continued to improve gradually to 1 year (1 day: 12.2±3.4, 14 days: 6.8±4.0, 1 year: 4.6±3.1).(4) The expansion ratio (endocardial length at 14 days/1 day) was significantly greater in the L group than in the S group (p<0.05). Comparing the groups, the LV cavity of the L group remained dilated up to 14 days, whereas that of the S and M groups was dilated up to 7 days (L group 14 days: 179.3±11.9 vs 1 day: 156.9±9.2mm, p<0.01; vs 1 year: 180.0±14.1mm, NS) (S group 7 days: 171.7±13.6 vs 1 day: 161.5±7.2mm, p<0.01; vs 1 year: 172.7±14.4mm, NS) (M group 7 days: 170.5±10.5 vs 1 day: 157.7±14.5mm, p<0.05; vs 1 year: 177.08±9.6mm, NS). Serial 2DE on days 1 and 14 after MI were useful for evaluating the course of LV remodeling and to forecast cardiac function in the chronic phase of MI. Determining the length of hospital stay on the basis of infarction size is justified.
- 社団法人日本循環器学会の論文
- 2000-05-20
著者
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Miyazaki Yoshiya
Department Of Cardiology Chiba Emergency Medical Center
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Yokoyama Masaki
Department Of Cardiology Chiba Rosai Hospital
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Ishibashi Iwao
Department of Cardiology, Chiba Emergency Medical Center
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Sakai Yoshiaki
Department of Cardiology, Chiba Emergency Medical Center
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MASUDA Yoshiaki
Third Department of Internal Medicine, Chiba University School of Medicine
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Ishibashi Iwao
Department Of Cardiology Chiba Emergency Medical Center
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Sakai Yoshiaki
Department Of Cardiology Chiba Emergency Medical Center
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Tsunoda Kouichi
Department of Cardiology, Chiba Medical Emergency Center
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Takahashi Osahiro
Kaihin Hospital
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Tsunoda Kouichi
Division of Cardiology, Chiba Emergency Medical Center
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Masuda Yoshiaki
Third Department Of Internal Medicine Chiba University
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Ishibashi Iwao
Division Of Cardiology Chiba Emergency Medical Center
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Tsunoda Kouichi
Division Of Cardiology Chiba Emergency Medical Center
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Yamaguchi Masashi
Department Of Cardiology Chiba Rosai Hospital
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