Møller Jacob E, Poulsen Steen H, Søndergaard Eva, Seward James B, Appleton Christopher P, Egstrup Kenneth
Department of Medicine, Svendborg Hospital, Svendborg, Denmark.
Int J Cardiol. 2003 Jun;89(2-3):207-15. doi: 10.1016/s0167-5273(02)00476-x.
In patients with heart failure due to chronic ischemic heart disease improvement of diastolic function indicates improved survival and a reduced morbidity, but whether this is also the case after acute myocardial infarction is not known.
To assess the prognostic importance of changes in left ventricular filling pattern, assessed with mitral deceleration time and colour M-mode flow propagation velocity, on cardiac death and readmission due to heart failure serial Doppler echocardiography was carried out in 103 patients with a first myocardial infarction. Based on echocardiography on hospital admission and after 1 month, patients were divided into three groups: group A (n=29) comprised patients with normal filling at either examination, group B (n=29) comprised patients with improvement of initially abnormal filling, and group C (n=45) patients with deterioration or no change of an abnormal filling pattern.
One-year survival free of cardiac death or hospitalisation for heart failure was 97% in group A, 86% in group B and 64% in group C (P<0.0001). In Cox analysis persistence of abnormal filling or deterioration of left ventricular filling was still a predictor of the combined endpoint (risk ratio 4.4, 95% CI 1.8-12.0, P=0.003) after adjustment of LV filling on admission, left ventricular systolic function and clinical variables. Serial analyses of left ventricular systolic function demonstrated a significant improvement after 1 year in ejection fraction in groups A and B, whereas ejection fraction remained unchanged in group C.
Patients with a persistently abnormal or a deterioration of left ventricular filling pattern as opposed to improved or normal filling are at increased risk of cardiac death and readmission due to heart failure after acute myocardial infarction.
在因慢性缺血性心脏病导致心力衰竭的患者中，舒张功能的改善表明生存率提高且发病率降低，但急性心肌梗死后是否也是如此尚不清楚。
为评估用二尖瓣减速时间和彩色M型血流传播速度评估的左心室充盈模式变化对心源性死亡和因心力衰竭再次入院的预后重要性，对103例首次发生心肌梗死的患者进行了系列多普勒超声心动图检查。根据入院时和1个月后的超声心动图检查结果，将患者分为三组：A组（n = 29）包括两次检查时充盈均正常的患者，B组（n = 29）包括最初异常充盈得到改善的患者，C组（n = 45）包括异常充盈模式恶化或无变化的患者。
A组无心脏死亡或因心力衰竭住院的1年生存率为97%，B组为86%，C组为64%（P<0.0001）。在Cox分析中，调整入院时的左心室充盈、左心室收缩功能和临床变量后，异常充盈的持续存在或左心室充盈的恶化仍是联合终点的预测因素（风险比4.4，95%可信区间1.8 - 12.0，P = 0.003）。左心室收缩功能的系列分析显示，A组和B组的射血分数在1年后有显著改善，而C组的射血分数保持不变。
与充盈改善或正常的患者相比，左心室充盈模式持续异常或恶化的患者在急性心肌梗死后发生心源性死亡和因心力衰竭再次入院的风险增加。
