安藤 浩巳, 小澤 優樹, 長谷川 雅一, 松崎 明廣, 鈴木 幹二郎, 片桐 敬

Hiromi ANDO, Masaki OZAWA, Masaichi HASEGAWA, Akihiro MATSUZAKI, Kanjiro SUZUKI, Takashi KATAGIRI

昭和大学医学部第三内科

The Third Department of Internal Medicine, Showa University School of Medicine

キーワード : Acute myocardial infarction, Trasient remote asynergy, Two dimensional echocardiography

To evaluate the clinical significance of transient remote asynergy (TRA) and the improvement of infarct-associated asynergy (IA) in acute myocardial infarction (AMI), we performed two-dimensional echocardiography on 63 patients with AMI and compared the asynergy grade on the 1st day with that on the 14th. We assessed hemodynamics, enzymatic infarct size, extent of coronary artery disease by coronary angiography, A/R ratio by doppler echocardiography, exrcise ECG test and ischemic cardiac events.
TRA was recognized in 26 and IA in 29 of the 63 patients. The cardiac index and ejection fractions of the left ventricle in the TRA group were significantly lower than those in the non-TRA group (p<0.05). TRA seemed to be unrelated to enzymatic infarct size, estimated with serial CK-MB measurements. Fifty-four patients underwent coronary angiography on admission. Twenty of 22 patients with TRA had multivessel diseases: one vessel disease (1 VD) 9.1% (2 of 22 patients), 2VD 54.5% (12 of 22 patients), 3VD 36.4%(8 of 22 patients). Thirty-one of 32 patients without TRA had 1VD (p<0.01). The A/R ratio, measured by doppler echocardiograms, was higher in the TRA group than the non-TRA group on the 1st day (p<0.05). Ischemic ECG changes caused by exercise testing appeared at a significantly higher rate of 43.3% in the TRA group. These were also found in 31.0% of the IA group (p<0.01). Patients with TRA or IA were at a high risk for new ischemic events such as reinfarction or recurrent angina pectoris. These were seen at a higher rate of 69.2% in 9 of 13 patients with both TRA and IA.
We conclude that it is useful when etimating the extent of coronary artery disease and prognostic implications of AMI to observe the asynergy of areas remote from the infarct site as well as infarct areas in the early stage of myocardial infarction.