| Objective: Ventricular systolic synchrony(VSS) is an important factor to maintain normal ventricular systolic and diastolic performance by regulating ventricular working at a coordinated and ordered state and producing optimal hemodynamic effects. Left ventricular aneurysm(LVA) is a serious complication of acute myocardial infraction (AMI) and influence prognosis of patients with AMI. However, there were few reports about that how to prevent and therapy LVA, especially the effects of percutaneous coronary intervention(PCI) on VSS, heart function in AMI patients with LVA. The aim of this paper was to evaluate the effects of direct PCI and rescue PCI on ventricular systolic synchrony and heart function in patients who suffered from AMI complicated LVA by coronary angiography (CAG), left ventriculography(LVG) and phase analysis (PA) of equilibrium radionuclide angiography (ERNA).Materials and methods: Twenty one patients with an initial acute myocardial infarction who received direct PCI or rescue PCI were enrolled this study from Jim, 2001 to Dec,2002. All patients were males. Average age was 51.62 ± 9.34 years old. The diagnosis of AMI was according with the criterion of WHO: 1) New onset of chest pain lasting more than half an hour; 2)The electrocardiographic evidence of ST-segment elevation that evolved into two or more bordering leads; 3) diagnostic elevation in creatine kinase (CK), CK-MB and or positive Troponin T. Patients were excluded if they had the history of old myocardial infarction, serious valvular heart disease, dilated and hypertrophic cardiomyopathy. The patients with cardiogenic shock (Killip class IV) and spontaneous or post-thrombolysis reperfusion of infarct-related artery (IRA) and A-V block/ left or right bundle branch block were also excluded. Patients were devided into direct PCI group and rescue PCI group. All patients were performed CAG, received the treatment of direct PCI or rescue PCI of IRA and were undergone LVG in right anterior oblique (RAO)30°, and a LVA was diagnosed on the criterion of The Coronary Artery Surgery Study (CASS) and Hirai, at the same time all the patients were performed ERNA, PA, measuring the parameters of VSS and LVSF, LVDF. Date were expressed as means ± S.D, P<0.05 considered significant.Results: 1. clinical features: There was no significant difference between the two groups about the age, sex , the levels of CK, CK-MB, a history of hypertension, hyperlipidemia, addication to smoking. Of 21 patients, 136 .patients had hypertension(62%), 6 patients had hyperlipidemia(29%), 17 patients had addiction to smoking (81%). All the patients were suffered from acute anterior or anterior-septal myocardial infarction. The formation of LVA has a close relation to the persistently occluded IRA, the occlusive time of IRA of patients with rescue PCI group and direct PCI group (16.11 ± 13.33 hour vs 6.92 ± 3.92 hour, p>0.05); 2. coronary angiography findings: of 21 patients, the proportion of patients showing one-vessel , two-vessel, three-vessel coronary artery lesion was 11 of 21 (52%), 8 of 21 (14%), 2 of 21 (14%) respectively, the IRA were all LAD which were total or subtotal occlusion in proximal or middle. 3. There was obvious delay in the phase imagine of myocardial infarction positions in the two groups at 2 weeks after the treatment of PCI, the extent of delay in the phase imagine of myocardial infarction positions in the two groups was decreased in two groups at 24 weeks. PS, PSD, FWHM in two groups were wider than that of normal people. The parameters of VSS with rescue PCI group were compared that of with direct PCI group, PS(105.33° ±35.31° vs 72.75 ± 15.87°P<0.05),PSD(22.67±10.33° vs 14.00±4.cS4° P -.0.05), PS, PSD were respectively increased by 45%, 62%, the results showed that the VSS of rescue PCI was better than that of direct PCI group; at 24 weeks, the parameters of two groups were lower than that of 2 weeks, the parameters of VSS with rescue PCI group were compared with that of patients withdire... |
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