Poulsen S H, Jensen S E, Egstrup K
Department of Medicine, Section of Cardiology, Haderslev Hospital, Haderslev, Denmark.
Am Heart J. 1999 May;137(5):910-8. doi: 10.1016/s0002-8703(99)70416-3.
Left ventricular (LV) diastolic dysfunction contributes to signs and symptoms of clinical heart failure and may be related to prognosis in heart diseases. LV diastolic dysfunction is reported to be present in acute myocardial infarction (MI); however, little is known about the time course of changes in LV diastolic function and its relation to prognosis after acute MI.
Two-dimensional and Doppler echocardiographic examinations were performed in 58 consecutive patients with first acute MI. The patients were studied serially within 1 hour and at days 5, 90, and 360 after arrival to the coronary care unit. LV diastolic function was assessed by Doppler measurements of transmitral and pulmonary venous flow. On the basis of mitral inflow, patients with MI were stratified at baseline to 3 LV diastolic filling patterns: normal, impaired relaxation, or pseudonormal/restrictive. Patients with MI were observed for development of congestive heart failure (Killip class >I) during hospitalization and for death during 1-year follow-up, and these complications were related to LV diastolic function. LV diastolic dysfunction was present in the very early phase of acute MI, with signs of impaired relaxation or restrictive LV filling dynamics in 38% and 24% of the patients, respectively, whereas 38% had normal LV filling characteristics. Impaired relaxation of the LV was most pronounced and found in 60% after 1-year follow-up. In-hospital congestive heart failure (Killip class >I) was found in 50% of the patients with initial impaired LV relaxation and in 71% of the patients with initially pseudonormal or restrictive LV filling dynamics, whereas patients with normal LV filling were free of heart failure. Patients with initial impaired relaxation and restrictive LV filling dynamics demonstrated a significant LV dilation during 1-year follow-up. Patients with initial pseudonormal/restrictive LV filling pattern were more frequently readmitted to the hospital for heart failure and had significant higher New York Heart Association class score compared with patients with normal or impaired relaxation during follow-up. Cardiac death was (n = 6) only observed in patients with pseudonormal or restrictive LV filling pattern. In a multivariate stepwise regression analysis, mitral E deceleration time </=140 ms and age were identified as independent variables related to development of in-hospital congestive heart failure and cardiac death during 12 months of follow-up.
LV diastolic dysfunction is present in the very early phase of MI. LV remodeling and development of in-hospital congestive heart failure appear in patients with very early signs of LV diastolic dysfunction. Furthermore, mitral E deceleration time </=140 ms best identified patients at risk of development of in-hospital congestive heart failure and cardiac death after MI.
左心室舒张功能障碍可导致临床心力衰竭的体征和症状，并且可能与心脏病的预后相关。据报道，急性心肌梗死（MI）患者存在左心室舒张功能障碍；然而，关于急性心肌梗死后左心室舒张功能变化的时间进程及其与预后的关系，人们知之甚少。
对58例连续发生首次急性心肌梗死的患者进行二维和多普勒超声心动图检查。患者在到达冠心病监护病房后1小时内以及第5天、90天和360天进行系列研究。通过多普勒测量二尖瓣和肺静脉血流来评估左心室舒张功能。根据二尖瓣血流，心肌梗死患者在基线时被分为3种左心室舒张充盈模式：正常、松弛受损或假性正常/限制性。观察心肌梗死患者住院期间充血性心力衰竭（Killip分级>I）的发生情况以及1年随访期间的死亡情况，并将这些并发症与左心室舒张功能相关联。急性心肌梗死的极早期即存在左心室舒张功能障碍，分别有38%和24%的患者出现松弛受损或左心室充盈动力学受限的体征，而38%的患者左心室充盈特征正常。左心室松弛受损在1年随访后最为明显，60%的患者出现该情况。住院期间，初始左心室松弛受损的患者中有50%发生充血性心力衰竭（Killip分级>I），初始左心室充盈动力学为假性正常或限制性的患者中有71%发生充血性心力衰竭，而左心室充盈正常的患者未发生心力衰竭。初始松弛受损和左心室充盈动力学受限的患者在1年随访期间左心室明显扩张。与随访期间左心室松弛正常或受损的患者相比，初始左心室充盈模式为假性正常/限制性的患者因心力衰竭再次住院的频率更高，纽约心脏协会分级评分也显著更高。仅在左心室充盈模式为假性正常或限制性的患者中观察到心源性死亡（n = 6）。在多因素逐步回归分析中，二尖瓣E峰减速时间≤140毫秒和年龄被确定为与随访12个月期间住院充血性心力衰竭和心源性死亡发生相关的独立变量。
心肌梗死极早期即存在左心室舒张功能障碍。左心室舒张功能障碍极早期体征的患者会出现左心室重构和住院充血性心力衰竭。此外，二尖瓣E峰减速时间≤140毫秒最能识别心肌梗死后有发生住院充血性心力衰竭和心源性死亡风险的患者。
