Sachero A, Casazza F, Recalcati F, de Maria R, Preti L, Mattioli R, Ferrari F, Capozzi A, Camerini F
Consorizo Antitubercolare, Servizio di Cardiologia, Milano.
G Ital Cardiol. 1992 Sep;22(9):1077-90.
To assess the prognostic role of echocardiographic indexes and their relation to clinical conditions, 225 patients with dilated cardiomyopathy were studied prospectively. All cases had a normal coronary angiogram and non specific endomyocardial biopsy findings. 163 men (72.4%) and 62 women (27.6%), mean age 41.5 +/- 12.3 (range 8-61), were studied. Clinical, electrocardiographic and echocardiographic parameters, normalized for body surface area, were tested according to NYHA class and presence of segmental or diffuse wall motion abnormalities. One hundred-four patients were in NYHA class I-IIa, 94 were in class IIb-III and 27 were in class IV. Left ventricular end systolic diameter index, right ventricular end diastolic diameter index, left atrial diameter index, left ventricular fractional shortening and ejection fraction, and radius to wall thickness ratio were significantly more impaired in patients with more severe symptoms. Twenty-eight patients (13%) showed segmental wall motion abnormalities and had smaller left ventricular end systolic and left atrial diameter index and higher left ventricular fractional shortening and ejection fraction. During a mean follow up of 23 +/- 15 months (range 1-67 months), 25 patients (11.1%) died from cardiac causes and 16 (7.1%) underwent heart transplant because of refractory heart failure. Prognostic evaluation was performed separately for cardiovascular mortality alone and for cardiac events (cardiovascular mortality and heart transplantation). At Cox multivariate analysis only right ventricular end diastolic diameter index (p < 0.005) predicted cardiovascular mortality, while left atrial diameter index (p < 0.001), right ventricular end diastolic diameter index (p < 0.01) and left ventricular ejection fraction (p < 0.05) were significant independent predictors of cardiac events.
为评估超声心动图指标的预后作用及其与临床状况的关系，我们对225例扩张型心肌病患者进行了前瞻性研究。所有病例冠状动脉造影正常，心内膜心肌活检结果无特异性。研究对象包括163名男性（72.4%）和62名女性（27.6%），平均年龄41.5±12.3岁（范围8 - 61岁）。根据纽约心脏协会（NYHA）心功能分级以及节段性或弥漫性室壁运动异常情况，对经体表面积校正的临床、心电图和超声心动图参数进行了检测。104例患者为NYHAⅠ - Ⅱa级，94例为Ⅱb - Ⅲ级，27例为Ⅳ级。症状较重的患者左心室收缩末期内径指数、右心室舒张末期内径指数、左心房内径指数、左心室缩短分数和射血分数以及半径与壁厚比值受损更明显。28例患者（13%）出现节段性室壁运动异常，其左心室收缩末期内径指数和左心房内径指数较小，左心室缩短分数和射血分数较高。在平均23±15个月（范围1 - 67个月）的随访期间，25例患者（11.1%）死于心脏原因，16例患者（7.1%）因难治性心力衰竭接受了心脏移植。分别对单纯心血管死亡率和心脏事件（心血管死亡率和心脏移植）进行了预后评估。在Cox多因素分析中，只有右心室舒张末期内径指数（p < 0.005）可预测心血管死亡率，而左心房内径指数（p < 0.001）、右心室舒张末期内径指数（p < 0.01）和左心室射血分数（p < 0.05）是心脏事件的显著独立预测因素。
