Coletta C, Sestili A, Seccareccia F, Rambaldi R, Ricci R, Galati A, Bigi R, Aspromonte N, Renzi M, Ceci V
Division of Cardiology and CCU, S Spirito Hospital, Rome, Italy.
Heart. 2003 Oct;89(10):1138-43. doi: 10.1136/heart.89.10.1138.
To assess the relative influence of contractile reserve and inducible ischaemia on subsequent left ventricular volume changes after myocardial infarction.
Left ventricular end diastolic and end systolic index volumes were calculated prospectively at discharge and at six months in 143 patients referred for early postinfarction dobutamine stress echocardiography. On the basis of their responses to this test, patients were divided into three groups: scar (n = 48; group 1); contractile reserve (n = 36; group 2); inducible ischaemia (n = 59; group 3).
At six months, the left ventricular end diastolic index volume decreased in group 2 (mean (SD), -3.9 (9.4) ml/m2) and increased in both group 1 (+2.8 (10.6) ml/m2, p = 0.009 v group 2) and group 3 (+7.5 (11.4) ml/m2, p < 0.0001 v group 2). The end systolic index volume decreased in group 2 (-4.9 (7.3) ml/m2) and increased in both group 1 (+1.3 (8.3) ml/m2, p = 0.0015 v group 2) and group 3 (+2.8 (8.9) ml/m2, p = 0.0002 v group 2). In multivariate analysis, the contractile reserve (hazard ratio 0.19, 95% confidence interval (CI) 0.14 to 0.47), inducible ischaemia (5.86, 95% CI 1.54 to 29.7), and end systolic index volume at discharge (1.04, 95% CI 0.99 to 1.11) were independent predictors of an increase in end diastolic index volume of > or = 15 ml/m2 at six months.
Contractile reserve and inducible ischaemia, as detected by early dobutamine stress echocardiography, identify patients with differences in long term left ventricular remodelling after acute myocardial infarction.
评估收缩储备和诱发性缺血对心肌梗死后左心室容积变化的相对影响。
前瞻性计算143例因心肌梗死后早期多巴酚丁胺负荷超声心动图检查而就诊的患者出院时及6个月时的左心室舒张末期和收缩末期指数容积。根据他们对该检查的反应，将患者分为三组：瘢痕组（n = 48；第1组）；收缩储备组（n = 36；第2组）；诱发性缺血组（n = 59；第3组）。
6个月时，第2组左心室舒张末期指数容积下降（均值（标准差），-3.9（9.4）ml/m²），第1组（+2.8（10.6）ml/m²，与第2组相比p = 0.009）和第3组（+7.5（11.4）ml/m²，与第2组相比p < 0.0001）均升高。第2组收缩末期指数容积下降（-4.9（7.3）ml/m²），第1组（+1.3（8.3）ml/m²，与第2组相比p = 0.0015）和第3组（+2.8（8.9）ml/m²，与第2组相比p = 0.0002）均升高。多变量分析显示，收缩储备（风险比0.19，95%置信区间（CI）0.14至0.47）、诱发性缺血（5.86，95%CI 1.54至29.7）以及出院时的收缩末期指数容积（1.04，95%CI 0.99至1.11）是6个月时舒张末期指数容积增加≥15 ml/m²的独立预测因素。
早期多巴酚丁胺负荷超声心动图检测到的收缩储备和诱发性缺血可识别急性心肌梗死后长期左心室重构存在差异的患者。
