Sicari Rosa, Picano Eugenio, Cortigiani Lauro, Borges Adrian C, Varga Albert, Palagi Caterina, Bigi Riccardo, Rossini Roberta, Pasanisi Emilio
CNR, Institute of Clinical Physiology, Pisa, Italy.
Am J Cardiol. 2003 Dec 1;92(11):1263-6. doi: 10.1016/j.amjcard.2003.08.004.
This study assesses the prognostic value of myocardial viability recognized as a contractile response to inotropic stimulation in patients with left ventricular (LV) dysfunction in a large-scale prospective, multicenter, observational study. Four hundred twenty-five patients (mean age 61 +/- 10 years) with angiographically proven coronary artery disease, previous (>3 months) myocardial infarction, and severe LV dysfunction (ejection fraction <35%; mean 28 +/- 6%) were enrolled in the study. Each patient underwent low-dose dobutamine echocardiography (up to 10 microg/kg/min). Myocardial viability was identified as a rest-stress variation (Delta) in the wall motion score index (WMSI), in which each segment was scored from 1 = normal to 4 = dyskinetic in a 16-segment model of the left ventricle. Myocardial viability was identified as an improvement of >/=0.40 in WMSI. All patients were followed for a median of 3.1 years. One hundred eighty-eight were revascularized either by coronary artery bypass grafting (n = 118) or coronary angioplasty (n = 70). The only end point analyzed was cardiac death. In the revascularized group, cardiac death occurred in 4 of the 52 patients with and in 37 of the 136 patients without myocardial viability (7.7% vs 27.2%, p <0.003). Kaplan-Meier survival estimates showed a better outcome for those patients with compared to patients without myocardial viability who underwent coronary revascularization (90.1% vs 62%, p <0.0078). Thus, in severe LV ischemic dysfunction, myocardial viability by low-dose dobutamine echocardiography is associated with improved survival in revascularized patients.
本研究在一项大规模前瞻性、多中心观察性研究中，评估了在左心室（LV）功能不全患者中，被视为对正性肌力刺激产生收缩反应的心肌存活性的预后价值。425例患者（平均年龄61±10岁）入选本研究，这些患者经血管造影证实患有冠状动脉疾病、既往（>3个月）心肌梗死且存在严重左心室功能不全（射血分数<35%；平均28±6%）。每位患者均接受了低剂量多巴酚丁胺超声心动图检查（最高达10μg/kg/min）。心肌存活性通过壁运动评分指数（WMSI）的静息-负荷变化（Δ）来确定，在左心室16节段模型中，每个节段的评分从1 =正常到4 =运动障碍。心肌存活性被确定为WMSI改善≥0.40。所有患者的中位随访时间为3.1年。188例患者接受了血运重建，其中冠状动脉旁路移植术（n = 118）或冠状动脉成形术（n = 70）。唯一分析的终点是心源性死亡。在血运重建组中，52例有心肌存活性的患者中有4例发生心源性死亡，136例无心肌存活性的患者中有37例发生心源性死亡（7.7%对27.2%，p<0.003）。Kaplan-Meier生存估计显示，与接受冠状动脉血运重建但无心肌存活性的患者相比，有心肌存活性的患者预后更好（90.1%对62%，p<0.0078）。因此，在严重左心室缺血性功能不全中，通过低剂量多巴酚丁胺超声心动图检测到的心肌存活性与血运重建患者的生存率提高相关。
