急性心肌梗死中左心室收缩和舒张心肌综合性能的多普勒衍生指数的系列变化及预后意义

Serial changes and prognostic implications of a Doppler-derived index of combined left ventricular systolic and diastolic myocardial performance in acute myocardial infarction.

作者信息

Poulsen S H, Jensen S E, Nielsen J C, Møller J E, Egstrup K

机构信息

Department of Medicine, Haderslev Hospital, Denmark.

出版信息

Am J Cardiol. 2000 Jan 1;85(1):19-25. doi: 10.1016/s0002-9149(99)00599-8.

DOI:10.1016/s0002-9149(99)00599-8

PMID:11078230

Abstract

The purpose of this study was to investigate the serial changes and prognostic value of a nongeometric Doppler-derived index of myocardial function that combines systolic and diastolic time intervals of the left ventricle in acute myocardial infarction (AMI). The Doppler index was measured in 60 consecutive patients with AMI and in 30 patients admitted to hospital with suspected but disproved AMI who served as controls. The patients were studied at days 1, 5, 90, and 360 after arrival in the coronary care unit. The index was defined as the sum of isovolumetric contraction time, and isovolumetric relaxation time divided by ejection time was measured from mitral inflow and left ventricular outflow Doppler velocity profiles. The index was significantly higher in patients with AMI than in control subjects at days 1 and 360 (day 1, 0.58 +/- 0.09 vs 0.41 +/- 0.08, p <0.0001; day 360, 0.50 +/- 0.09 vs 0.39 +/- 0.07, p <0.01, respectively). The index decreased significantly in patients with AMI during follow-up (p <0.01). The index was significantly higher in patients who developed congestive heart failure or died compared with survivors who were free of congestive heart failure (day 1, 0.63 +/- 0.10 vs 0.53 +/- 0.10, p <0.01; day 360, 0.56 +/- 0.08 vs 0.48 +/- 0.10, p <0.01, respectively). During 20.2 +/- 8.5 months' follow-up, 10 patients died of cardiac causes and 13 developed congestive heart failure. Univariate analyses demonstrated that the Doppler index > or =0.60 (chi-square 8.3, p <0.0001), deceleration time < or =140 ms (chi-square 8.5, p <0.0001), ejection fraction < or =0.40% (chi-square 3.3, p <0.005), anterior wall AMI (chi-square 3.2, p <0.01), and age (chi-square 1.06/ year increase, p <0.01) were significant predictors of outcome. Multivariate stepwise analysis showed that the index < or =0.60 (chi-square 3.4, p <0.05), deceleration time < or =140 ms (chi-square 4.2, p <0.02), and age (chi-square 1.06/year increase, p <0.02) were independent predictors of outcome. The Doppler index reflects severity of left ventricular function and has incremental prognostic value in patients with AMI.

摘要

本研究旨在探讨一种非几何多普勒衍生的心肌功能指数的系列变化及其在急性心肌梗死（AMI）中的预后价值，该指数结合了左心室的收缩和舒张时间间期。对60例连续的AMI患者以及30例因疑似AMI入院但最终排除诊断的患者（作为对照）进行了多普勒指数测量。患者在进入冠心病监护病房后的第1天、第5天、第90天和第360天接受研究。该指数定义为等容收缩时间与等容舒张时间之和，通过二尖瓣流入和左心室流出多普勒速度曲线测量其除以射血时间的值。在第1天和第360天，AMI患者的该指数显著高于对照组（第1天，0.58±0.09 vs 0.41±0.08，p<0.0001；第360天，0.50±0.09 vs 0.39±0.07，p<0.01）。在随访期间，AMI患者的该指数显著下降（p<0.01）。与无充血性心力衰竭的幸存者相比，发生充血性心力衰竭或死亡的患者该指数显著更高（第1天，0.63±0.10 vs 0.53±0.10，p<0.01；第360天，0.56±0.08 vs 0.48±0.10，p<0.01）。在20.2±8.5个月的随访期间，10例患者死于心脏原因，13例发生充血性心力衰竭。单因素分析表明，多普勒指数≥0.60（χ²=8.3，p<0.0001）、减速时间≤140 ms（χ²=8.5，p<0.0001）、射血分数≤0.40%（χ²=3.3，p<0.005）、前壁AMI（χ²=3.2，p<0.01）以及年龄（χ²=1.06/年增长，p<0.01）是预后的重要预测因素。多因素逐步分析显示，指数≤0.60（χ²=3.4，p<0.05）、减速时间≤140 ms（χ²=4.2，p<0.02）以及年龄（χ²=1.06/年增长，p<0.02）是预后的独立预测因素。多普勒指数反映了左心室功能的严重程度，对AMI患者具有额外的预后价值。