Ascione Luigi, De Michele Mario, Accadia Maria, Rumolo Salvatore, Damiano Lucia, D'Andrea Antonello, Guarini Pasquale, Tuccillo Bernardino
S. Maria di Loreto Hospital, Naples, Italy.
J Am Soc Echocardiogr. 2003 Oct;16(10):1019-23. doi: 10.1016/S0894-7317(03)00589-3.
We sought to assess the ability of a Doppler index of global myocardial performance (MPI), measured at entry, to predict inhospital cardiac events in a series of patients with first acute myocardial infarction (AMI).
A complete 2-dimensional and Doppler echocardiographic examination was performed within 24 hours of arrival at the coronary care department in 96 patients (81 men and 15 women; mean age 58 +/- 9 years) with first AMI. Patients were divided a posteriori into 2 groups according to their inhospital course: group 1 comprised 75 patients with an uneventful course and group 2 comprised 21 patients with a complicated inhospital course (death, heart failure, arrhythmias, or post-AMI angina).
There were no significant differences between the 2 groups with regard to history of hypertension, diabetes mellitus, hypercholesterolemia, site and size of infarction, and conventional parameters of diastolic function. However, patients with complications were significantly older (63 +/- 10 vs 55 +/- 8 years, P =.005) and had higher wall-motion score index and left ventricular end-systolic volume compared with patients without events (1.84 +/- 0.27 vs 1.52 +/- 0.30, P =.001; and 66 +/- 29 vs 47 +/- 21 mL, P =.009, respectively), whereas the ejection fraction was reduced (40 +/- 10% vs 52 +/- 10%, P =.0001). The mean value of the MPI was significantly higher in patients with cardiac events than in those without events (0.65 +/- 0.20 vs 0.43 +/- 0.16, P =.0001). A MPI >/= 0.47 showed a sensitivity of 90% and specificity of 68% for identifying patients with events, on the basis of the receiver operator curve. In a multivariable model, the MPI at admission remained independently predictive of inhospital cardiac events (odds ratio 15.6, 95% confidence interval 2.4-99, P =.003).
These data suggest that in the acute phase of AMI, the MPI measured at entry may be useful to predict which patients are at high risk for inhospital cardiac events.
我们试图评估入院时测量的整体心肌功能多普勒指数（MPI）预测一系列首次急性心肌梗死（AMI）患者院内心脏事件的能力。
对96例首次发生AMI的患者（81例男性和15例女性；平均年龄58±9岁）在到达冠心病监护病房后24小时内进行完整的二维和多普勒超声心动图检查。根据患者的院内病程事后将其分为2组：第1组包括75例病程平稳的患者，第2组包括21例院内病程复杂的患者（死亡、心力衰竭、心律失常或AMI后心绞痛）。
两组在高血压、糖尿病、高胆固醇血症病史、梗死部位和大小以及舒张功能的传统参数方面无显著差异。然而，有并发症的患者明显年龄更大（63±10岁对55±8岁，P = 0.005），与无事件的患者相比，其壁运动评分指数和左心室收缩末期容积更高（分别为1.84±0.27对1.52±0.30，P = 0.001；66±29对47±21 mL，P = 0.009），而射血分数降低（40±10%对52±10%，P = 0.0001）。发生心脏事件的患者的MPI平均值显著高于无事件的患者（0.65±0.20对0.43±0.16，P = 0.0001）。根据受试者工作特征曲线，MPI≥0.47识别有事件患者的敏感性为90%，特异性为68%。在多变量模型中，入院时的MPI仍然独立预测院内心脏事件（比值比15.6，95%置信区间2.4 - 99，P = 0.003）。
这些数据表明，在AMI急性期，入院时测量的MPI可能有助于预测哪些患者发生院内心脏事件的风险较高。
