Devereux Richard B, Roman Mary J, Palmieri Vittorio, Liu Jennifer E, Lee Elisa T, Best Lyle G, Fabsitz Richard R, Rodeheffer Richard J, Howard Barbara V
Cornell Medical Center, New York, NY, USA.
Am Heart J. 2003 Sep;146(3):527-34. doi: 10.1016/S0002-8703(03)00229-1.
Although echocardiography is commonly used to assess left ventricular (LV) systolic function, few data are available concerning the prognostic significance of LV ejection fraction (EF) calculated from linear echocardiographic measurements or 2-dimensional (2-D) wall motion scores in population-based samples.
Echocardiography was used in the second Strong Heart Study (SHS) examination to calculate LV EF in 2948 American Indians without prevalent coronary heart disease; 2923 had 2-D wall motion scores.
Mildly and severely reduced LV EF occurred in 10% and 2% of participants, was associated with older age, male sex, higher systolic pressure, heart rate and markers of renal disease and inflammation. During 37 +/- 9 months follow-up, cardiovascular death occurred in 2%, 5% and 12% of participants with normal, mildly reduced and severely reduced EF; all cause mortality rates were 6%, 10% and 32% (both P <.001). In Cox proportional hazards analyses, adjusting for covariates, cardiovascular death was higher with mildly reduced EF (risk ratio [RR] 2.9, 95% CI 1.6-5.4, P =.0007) and especially with severely reduced EF (RR 6.9, 95% CI 3.0-15.9, P <.0001); all-cause mortality was increased with severe LV dysfunction (RR 4.8, 95% CI 2.8-8.1, P <.001) and marginally with mildly reduced EF (odds ratio 1.4, 95% CI 0.95-2.15, P =.08). Segmental LV dysfunction and mildly and severely reduced EF from 2-D wall motion scores were associated with 3.3-fold (95% CI 1.1-9.4, P =.02), 3.5-fold (95% CI 2.1-5.8) and 3.8-fold (95% CI 1.9-7.6) (all P <.001) increased rates of cardiovascular death.
LV EF from linear echocardiographic measurements as well as segmental LV dysfunction and EF from 2-D wall motion scores strongly and independently predict cardiovascular mortality. Reduced EF by simple echocardiographic method has estimated population-attributable risks of about 35% for cardiovascular death and 12% for all-cause mortality in a population-based sample of middle-aged to elderly adults.
虽然超声心动图常用于评估左心室（LV）收缩功能，但关于基于人群样本中通过线性超声心动图测量或二维（2-D）壁运动评分计算得出的左心室射血分数（EF）的预后意义，可用数据较少。
在第二次强心脏研究（SHS）检查中使用超声心动图，对2948名无冠心病病史的美国印第安人计算左心室EF；2923人有二维壁运动评分。
10%和2%的参与者出现轻度和重度左心室EF降低，与年龄较大、男性、较高的收缩压、心率以及肾病和炎症标志物相关。在37±9个月的随访期间，EF正常、轻度降低和重度降低的参与者中心血管死亡发生率分别为2%、5%和12%；全因死亡率分别为6%、10%和32%（P均<.001）。在Cox比例风险分析中，调整协变量后，轻度EF降低者心血管死亡风险更高（风险比[RR]2.9，95%可信区间1.6 - 5.4，P =.0007），尤其是重度EF降低者（RR 6.9，95%可信区间3.0 - 15.9，P <.0001）；严重左心室功能障碍者全因死亡率增加（RR 4.8，95%可信区间2.8 - 8.1，P <.001），轻度EF降低者全因死亡率略有增加（优势比1.4，95%可信区间0.95 - 2.15，P =.08）。二维壁运动评分显示的节段性左心室功能障碍以及轻度和重度EF降低与心血管死亡发生率分别增加3.3倍（95%可信区间1.1 - 9.4，P =.02）、3.5倍（95%可信区间2.1 - 5.8）和3.8倍（95%可信区间1.9 - 7.6）（P均<.001）相关。
通过线性超声心动图测量得出的左心室EF以及二维壁运动评分显示的节段性左心室功能障碍和EF能强烈且独立地预测心血管死亡率。在基于人群的中老年样本中，通过简单超声心动图方法测得的EF降低对心血管死亡的人群归因风险估计约为35%，对全因死亡率的人群归因风险估计约为12%。
