Neglia Danilo, Michelassi Claudio, Trivieri Maria Giovanna, Sambuceti Gianmario, Giorgetti Assuero, Pratali Lorenza, Gallopin Michela, Salvadori Piero, Sorace Oreste, Carpeggiani Clara, Poddighe Rosa, L'Abbate Antonio, Parodi Oberdan
C.N.R. Institute of Clinical Physiology, Pisa, Italy.
Circulation. 2002 Jan 15;105(2):186-93. doi: 10.1161/hc0202.102119.
Depressed myocardial blood flow (MBF) has been reported in dilated cardiomyopathy. The aim of this study was to investigate whether MBF impairment is an independent predictor of prognosis in patients with idiopathic left ventricular (LV) dysfunction.
Sixty-seven patients (52 male, mean age 52+/-12 years) with different degrees of idiopathic LV systolic dysfunction (average LV ejection fraction, 0.34+/-0.10; range, 0.07 to 0.49) were prospectively enrolled. Thirty-four subjects (51%) had no history of heart failure symptoms at enrollment (NYHA class I). All patients underwent clinical and functional evaluation and a PET study to measure absolute MBF at rest and after intravenous dipyridamole. During a mean follow-up of 45+/-37 months, 24 patients had major cardiac events, including cardiac death in 8 and development or progression of heart failure in 16 patients. Multivariate regression analysis (Cox proportional hazards model) revealed heart rate (chi(2) 11.06, P<0.001), LV end-diastolic dimension (chi(2) 11.73, P<0.001), and dipyridamole MBF (chi(2) 11.04, P<0.001) as independent predictors of subsequent cardiac events. Dipyridamole MBF < or = 1.36 mL. min(-1). g(-1) was associated with an increase in the relative risk of death, development, or progression of heart failure of 3.5 times over other more common clinical and functional variables.
The present study demonstrates that severely depressed MBF is a predictor of poor prognosis in patients with idiopathic LV dysfunction independently of the degree of LV functional impairment and of the presence of overt heart failure.
已有报道称扩张型心肌病患者存在心肌血流（MBF）降低的情况。本研究旨在探讨MBF受损是否为特发性左心室（LV）功能障碍患者预后的独立预测因素。
前瞻性纳入67例不同程度特发性LV收缩功能障碍患者（52例男性，平均年龄52±12岁）（平均LV射血分数为0.34±0.10；范围为0.07至0.49）。34例受试者（51%）在入组时无心力衰竭症状史（纽约心脏协会I级）。所有患者均接受临床和功能评估以及PET研究，以测量静息和静脉注射双嘧达莫后的绝对MBF。在平均45±37个月的随访期间，24例患者发生了主要心脏事件，包括8例心源性死亡和16例心力衰竭的发生或进展。多因素回归分析（Cox比例风险模型）显示心率（χ2 11.06，P<0.001）、LV舒张末期内径（χ2 11.73，P<0.001）和双嘧达莫MBF（χ2 11.04，P<0.001）是后续心脏事件的独立预测因素。双嘧达莫MBF≤1.36 mL·min-1·g-1与死亡、心力衰竭发生或进展的相对风险增加相关，是其他更常见临床和功能变量的3.5倍。
本研究表明，严重降低的MBF是特发性LV功能障碍患者预后不良的预测因素，与LV功能损害程度和明显心力衰竭的存在无关。
