Davis R C, Hobbs F D R, Kenkre J E, Roalfe A K, Hare R, Lancashire R J, Davies M K
Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT, UK.
BMJ. 2002 Nov 16;325(7373):1156. doi: 10.1136/bmj.325.7373.1156.
To determine the prevalence of left ventricular systolic dysfunction, and of heart failure due to different causes, in patients with risk factors for these conditions.
Epidemiological study, including detailed clinical assessment, electrocardiography, and echocardiography.
16 English general practices, representative for socioeconomic status and practice type.
1062 patients (66% response rate) with previous myocardial infarction, angina, hypertension, or diabetes.
Prevalence of systolic dysfunction, both with and without symptoms, and of heart failure, in groups of patients with each of the risk factors.
Definite systolic dysfunction (ejection fraction <40%) was found in 54/244 (22.1%, 95% confidence interval 17.1% to 27.9%) patients with previous myocardial infarction, 26/321 (8.1%, 5.4% to 11.6%) with angina, 7/388 (1.8%, 0.7% to 3.7%) with hypertension, and 12/208 (5.8%, 3.0% to 9.9%) with diabetes. In each group, approximately half of these patients had symptoms of dyspnoea, and therefore had heart failure. Overall rates of heart failure, defined as symptoms of dyspnoea plus objective evidence of cardiac dysfunction (systolic dysfunction, atrial fibrillation, or clinically significant valve disease) were 16.0% (11.6% to 21.2%) in patients with previous myocardial infarction, 8.4% (5.6% to 12.0%) in those with angina, 2.8% (1.4% to 5.0%) in those with hypertension, and 7.7% (4.5% to 12.2%) in those with diabetes.
Many people with ischaemic heart disease or diabetes have systolic dysfunction or heart failure. The data support the need for trials of targeted echocardiographic screening, in view of the major benefits of modern treatment. In contrast, patients with uncomplicated hypertension have similar rates to the general population.
确定存在这些疾病危险因素的患者中左心室收缩功能障碍及不同病因所致心力衰竭的患病率。
流行病学研究，包括详细的临床评估、心电图检查和超声心动图检查。
16家英国全科诊所，代表社会经济地位和诊所类型。
1062例曾患心肌梗死、心绞痛、高血压或糖尿病的患者（应答率66%）。
各危险因素患者组中收缩功能障碍（有症状和无症状）及心力衰竭的患病率。
在曾患心肌梗死的244例患者中，54例（22.1%，95%置信区间17.1%至27.9%）存在明确的收缩功能障碍（射血分数<40%）；在患心绞痛的321例患者中，26例（8.1%，5.4%至11.6%）存在；在患高血压的388例患者中，7例（1.8%，0.7%至3.7%）存在；在患糖尿病的208例患者中，12例（5.8%，3.0%至9.9%）存在。在每组中，约一半此类患者有呼吸困难症状，因此患有心力衰竭。定义为呼吸困难症状加心脏功能障碍客观证据（收缩功能障碍、心房颤动或具有临床意义的瓣膜病）的总体心力衰竭发生率，在曾患心肌梗死的患者中为16.0%（11.6%至21.2%），在患心绞痛的患者中为8.4%（5.6%至12.0%），在患高血压的患者中为2.8%（1.4%至5.0%），在患糖尿病的患者中为7.7%（4.5%至12.2%）。
许多患有缺血性心脏病或糖尿病的人存在收缩功能障碍或心力衰竭。鉴于现代治疗的重大益处，这些数据支持开展有针对性的超声心动图筛查试验的必要性。相比之下，无并发症的高血压患者发生率与普通人群相似。
