Zusammenfassung
Ziel der Untersuchung war, herauszufinden, ob auch in der chronischen Infarktphase eine kausale antiischämische Intervention i. S. einer perkutanen transluminalen Koronarangioplastie (PTCA) zur einer Reduktion ventrikulärer Spätpotentiale führt. Bei 24 Patienten wurden im Abstand von 6,0±4,2 Monaten (Gruppe A, mit PTCA) bzw. von 6,2±5,2 Monaten (Gruppe B, konservative Therapie) Messungen des signalgemittelten EKG zur Analyse ventrikulärer Spätpotentiale (LP) durchgeführt. Alle Patienten hatten einen abgelaufenen Myokardinfarkt in der Vorgeschichte. Spätpotentiale galten als positiv, wenn mindestens zwei Kriterien positiv waren. Im Gesamtkollektiv wiesen 73% der Patienten positive Spätpotentiale auf. In Gruppe A wurde binnen eines monats nach initialer Spätpotentialmessung die PTCA durchgeführt. Danach kam es zu einer signifikanten Abnahme LP-positiver Patienten (von 64% auf 18%), während in Gruppe B die Anzahl LP-positiver Patienten nur tendenziell abnahm (85% vs. 62%). Auch die signalgemittelten Einzelkriterien veränderten sich in Gruppe A z. T. signifikant (QRS 113,04±13,65 vs. 100,55±6,97 ms; p<0.01, RMS 24,05±24,13 vs. 35,39±16,89 μV; n.s., LAS 41,23±13,27 vs. 29,68±6,47 ms; p<0.05). In Gruppe B kam es zu keinen signifikanten Veränderungen.
Zusammenfassend zeigen diese Ergebnisse, daß auch in der chronischen Postinfarktphase eine PTCA des Infarktgefäßes bei stenosierender KHK zu einer Reduktion von ventrikulären Spätpotentialen führen kann. Ob dadurch auch die Prognose der Patienten verbessert wird, müssen zukünftige Untersuchungen zeigen.
Summary
The aim of the study was to evaluate whether a causal antiischemic intervention as percutaneous transluminal coronary angioplasty (PTCA) leads to a reduction of ventricular late potentials in the chronic post myocardial infarction period. In 24 patients, signal-averaged electrocardiograms (SAECG) for two groups were recorded for the analysis of ventricular late potentials (LP) before and after 6.0±4.2 months (group A, with PTCA) and 6.2±5.2 months, respectively (group B, conservative therapy). All patients presented prior myocardial infarction. LP were defined present if two of the three time domain criteria were met. In the whole study group, LP were positive in 73%. In group A, a PTCA was performed one month after the initial SAECG measurement. In group A, the presence of ventricular late potentials was significantly reduced (64% vs. 18%), whereas in group B only a slight decline of late potentials could be observed (85% vs. 62%). The parameters of the signal averaged ECG varied significantly in group A before and after PTCA (QRS 113.04±13.65 vs. 100.55±6.97 ms (p<0.05), RMS 24.04±24.13 vs. 35.39±16.89 μV (p=n.s.), LAS 41.23±13.27 vs. 29.68±6.47 ms (p<0.05)). The results in group B were not altered significantly.
In conclusion, these results show that a PTCA of the infarct-related artery can lead to a reduction in ventricular late potentials in patients with significant coronary artery disease, who are also in the chronic post myocardial infarction period. Whether it is possible to improve the prognosis of these patients has also to be shown in future studies.
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Hennersdorf, M., Perings, C., Schoebel, F.C. et al. Einfluß einer perkutanen transluminalen Koronarangioplastie auf die Ausprägung ventrikulärer Spätpotentiale bei Patienten mit abgelaufenem Myokardinfarkt. Herzschr Elektrophys 8, 205–212 (1997). https://doi.org/10.1007/BF03042403
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DOI: https://doi.org/10.1007/BF03042403