Elhendy Abdou, Mahoney Douglas W, Khandheria Bijoy K, Paterick Timothy E, Burger Kelli N, Pellikka Patricia A
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
J Am Coll Cardiol. 2002 Nov 6;40(9):1623-9. doi: 10.1016/s0735-1097(02)02338-0.
Our aim was to determine whether location of wall motion abnormalities (WMAs) during exercise echocardiography provides independent prognostic value.
The effect of the location of WMAs during stress echocardiography on prognostic outcome is unknown.
We studied 4,347 patients (mean age, 61 +/- 12 years; 2,230 men) with known or suspected coronary artery disease by symptom-limited exercise echocardiography. An abnormal result was defined as resting or exercise-induced WMA. End points were cardiac death and nonfatal myocardial infarction (MI).
There were 133 cardiac events (54 cardiac deaths and 79 nonfatal MIs) during follow-up (median, three years). In a multiple-stepwise multivariate analysis model, clinical and exercise electrocardiography predictors of cardiac events were age, gender, hypertension, typical chest pain, previous MI, smoking, and resting ejection fraction. The percentage of ischemic segments at peak exercise provided additional information to the model (p = 0.0001). The presence of abnormalities in the left anterior descending (LAD) coronary artery distribution had an additional independent effect for the prediction of cardiac events (p = 0.001). Among patients with exercise echocardiographic abnormalities in a single vascular region, those with abnormalities in the left anterior descending coronary artery distribution had a higher event rate than patients with abnormalities elsewhere (3.2% vs. 2.1% at three years and 10.8% vs. 2.1% at five years; p = 0.009). CONCLUSIONS; Exercise WMAs in the distribution of the LAD coronary artery are associated with an increased risk of cardiac death and nonfatal MI. This risk is independent of the resting ejection fraction and the extent of WMAs during exercise.
我们的目的是确定运动超声心动图期间室壁运动异常（WMA）的位置是否具有独立的预后价值。
负荷超声心动图期间WMA的位置对预后结果的影响尚不清楚。
我们通过症状限制性运动超声心动图研究了4347例已知或疑似冠心病患者（平均年龄61±12岁；男性2230例）。异常结果定义为静息或运动诱发的WMA。终点为心源性死亡和非致死性心肌梗死（MI）。
随访期间（中位数为3年）发生了133例心脏事件（54例心源性死亡和79例非致死性MI）。在多步骤多变量分析模型中，心脏事件的临床和运动心电图预测因素为年龄、性别、高血压、典型胸痛、既往MI、吸烟和静息射血分数。运动高峰时缺血节段的百分比为该模型提供了额外信息（p = 0.0001）。左前降支（LAD）冠状动脉分布区域存在异常对心脏事件的预测具有额外的独立作用（p = 0.001）。在单一血管区域存在运动超声心动图异常的患者中，左前降支冠状动脉分布区域存在异常的患者的事件发生率高于其他部位存在异常的患者（3年时为3.2%对2.1%，5年时为10.8%对2.1%；p = 0.009）。结论：LAD冠状动脉分布区域的运动WMA与心源性死亡和非致死性MI风险增加相关。这种风险独立于静息射血分数和运动期间WMA的范围。
