Hara Y, Hamada M, Hiwada K
The Second Department of Internal Medicine, Ehime University School of Medicine, Japan.
Jpn Circ J. 1999 Mar;63(3):196-200. doi: 10.1253/jcj.63.196.
Dilated cardiomyopathy is an important cause of morbidity and mortality among patients with heart failure. Left ventricular dilation is viewed as a compensatory response to maintain stroke volume, and left ventricular dilation is directly related to the increase of wall stress. However, only a few studies have examined whether wall stress can be a prognostic variable in patients with dilated cardiomyopathy. This study was designed to elucidate whether left ventricular systolic wall stress was related to the prognosis in patients with dilated cardiomyopathy. Twenty-five normal control subjects and 68 patients with dilated cardiomyopathy participated in this study. Hemodynamic parameters and left ventricular systolic wall stress were determined using echocardiography. In addition, the extent score determined by thallium-201 myocardial scintigraphy was measured as an index of cumulative loss of myocardium. During the 53-month follow-up period, 13 patients died of cardiac events. In a stepwise multivariable analysis, end-systolic wall stress and fractional shortening were significant predictors of survival. The extent score was markedly greater in the patients who died than in alive patients. There was a significant correlation between end-systolic wall stress and extent score (r=0.501, p=0.0001). Left ventricular end-systolic wall stress is an important predictor of mortality in patients with dilated cardiomyopathy.
扩张型心肌病是心力衰竭患者发病和死亡的重要原因。左心室扩张被视为维持心输出量的一种代偿反应，且左心室扩张与壁应力增加直接相关。然而，仅有少数研究探讨了壁应力是否可作为扩张型心肌病患者的预后变量。本研究旨在阐明左心室收缩期壁应力是否与扩张型心肌病患者的预后相关。25名正常对照者和68名扩张型心肌病患者参与了本研究。使用超声心动图测定血流动力学参数和左心室收缩期壁应力。此外，测量由铊-201心肌闪烁显像确定的范围评分，作为心肌累积损失的指标。在53个月的随访期内，13名患者死于心脏事件。在逐步多变量分析中，收缩末期壁应力和缩短分数是生存的显著预测因素。死亡患者的范围评分明显高于存活患者。收缩末期壁应力与范围评分之间存在显著相关性（r = 0.501，p = 0.0001）。左心室收缩末期壁应力是扩张型心肌病患者死亡率的重要预测因素。
