左心室功能严重降低与接近正常的心肌梗死幸存者未来心脏事件风险分层的效用：一项前瞻性长期随访研究的结果

Usefulness of risk stratification for future cardiac events in infarct survivors with severely depressed versus near-normal left ventricular function: results from a prospective long-term follow-up study.

作者信息

Klingenheben Thomas, Hohnloser Stefan H

机构信息

Department of Medicine, Division of Clinical Electrophysiology, J.W. Goethe University Hospital, Frankfurt, Germany.

出版信息

Ann Noninvasive Electrocardiol. 2003 Jan;8(1):68-74. doi: 10.1046/j.1542-474x.2003.08111.x.

DOI:10.1046/j.1542-474x.2003.08111.x

PMID:12848816

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6932315/

Abstract

BACKGROUND

Although primary preventive therapy with implantable cardioverter defibrillators has recently been shown to be effective in patients with coronary artery disease and left ventricular dysfunction, further identification of patients at particularly high risk for arrhythmic death would improve the cost effectiveness of device therapy. The value of risk stratification in postinfarction patients with versus those without left ventricular dysfunction has not been investigated in detail in infarct survivors treated according to contemporary therapeutic guidelines.

METHODS

Patients with acute myocardial infarction underwent coronary angiography including left ventricular angiography in an attempt to restore antegrade flow of the infarct-related artery. Additionally, patients underwent noninvasive autonomic risk stratification by means of heart rate variability (HRV) and baroreflex sensitivity (BRS) measurements prior to hospital discharge.

RESULTS

A total of 411 patients were prospectively included in the study. The primary study endpoint of cardiac death and arrhythmic events was significantly more common in patients with LVEF < or = 35% as compared to those with preserved LV function (27% vs 4%; P < 0.0001). In patients with LV dysfunction, HRV and BRS were significant risk predictors on univariate (P < 0.01 for BRS; P = 0.04 for HRV) and multivariate (P = 0.028 for BRS; P = 0.053 for HRV) analyses. In contrast, in patients with preserved LV function, only patency of the infarct artery but not autonomic markers was significantly predictive of cardiac death and arrhythmic events.

CONCLUSION

The present study demonstrates that autonomic testing does not yield predictive power in infarct survivors with preserved left ventricular function. Accordingly, cost effectiveness of risk stratification and subsequent preventive therapy may be improved by restricting risk stratification to patients with impaired LV function.

摘要

背景

尽管近期研究表明，植入式心脏复律除颤器的一级预防治疗对冠心病合并左心室功能不全患者有效，但进一步识别心律失常死亡风险特别高的患者将提高器械治疗的成本效益。在按照当代治疗指南进行治疗的心肌梗死幸存者中，对于有和没有左心室功能不全的心肌梗死后患者，风险分层的价值尚未得到详细研究。

方法

急性心肌梗死患者接受了包括左心室血管造影在内的冠状动脉造影，以试图恢复梗死相关动脉的前向血流。此外，患者在出院前通过心率变异性（HRV）和压力反射敏感性（BRS）测量进行无创自主风险分层。

结果

共有411例患者前瞻性纳入本研究。与左心室功能保留的患者相比，左心室射血分数（LVEF）≤35%的患者心脏死亡和心律失常事件的主要研究终点明显更常见（27%对4%；P<0.0001）。在左心室功能不全的患者中，HRV和BRS在单因素分析（BRS，P<0.01；HRV，P=0.04）和多因素分析（BRS，P=0.028；HRV，P=0.053）中均为显著的风险预测因素。相比之下，在左心室功能保留的患者中，只有梗死动脉的通畅情况而非自主神经标志物能显著预测心脏死亡和心律失常事件。