Lopez-Jimenez Francisco, Goraya Tauqir Y, Hellermann Jens P, Jacobsen Steven J, Reeder Guy S, Weston Susan A, Roger Véronique L
Department of Health Sciences Research, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
Chest. 2004 Feb;125(2):397-403. doi: 10.1378/chest.125.2.397.
To assess the secular trends in left ventricular ejection fraction (LVEF) assessment after myocardial infarction (MI) and to identify the determinants of testing.
A population-based MI incidence cohort.
The use of tests measuring LVEF (echocardiography, radionuclide, and left ventricular [LV] angiography) was examined among all consecutive residents of Olmsted County, MN, hospitalized for a validated incident MI between 1979 and 1998. Baseline characteristics and outcome were ascertained from community medical records.
Among 2,317 patients with incident MI, LVEF assessment increased from 1979 to 1986 (22 to 85%; p value for trend = 0.0001) to stabilize thereafter until 1998. During the most recent decade, LVEF was measured during the hospital stay in 81% of the patients. Characteristics associated with lesser use of tests included older age and measurement of ejection fraction within 1 year prior to the index MI. Larger MI size, prolonged hospital stay, and involvement of a cardiologist as a care provider were positively associated with determination of LVEF.
Measurement of LVEF after MI increased in the last 2 decades, but there continues to be a group of patients in whom it is not done. Given the potential benefits of LVEF measurement, including knowledge for risk stratification and therapeutic choices as underscored in recent practice guidelines, there may be additional opportunities for improving outcomes by ensuring its more consistent use. However, as testing for LVEF differs according to patient characteristics, reliance on selected clinically performed LVEF measurements will result in biased estimates of the prevalence of LV dysfunction after MI.
评估心肌梗死（MI）后左心室射血分数（LVEF）评估的长期趋势，并确定检测的决定因素。
基于人群的MI发病率队列研究。
在明尼苏达州奥尔姆斯特德县所有因确诊的首次MI住院的连续居民中，检查了测量LVEF的检测方法（超声心动图、放射性核素和左心室[LV]血管造影）的使用情况。从社区医疗记录中确定基线特征和结局。
在2317例首次发生MI的患者中，LVEF评估从1979年至1986年有所增加（从22%增至85%；趋势p值=0.0001），此后直至1998年保持稳定。在最近十年中，81%的患者在住院期间进行了LVEF测量。与检测使用较少相关的特征包括年龄较大以及在本次MI之前1年内测量射血分数。MI面积较大、住院时间延长以及有心脏病专家作为护理提供者与LVEF的测定呈正相关。
在过去20年中，MI后LVEF的测量有所增加，但仍有一组患者未进行此项测量。鉴于LVEF测量的潜在益处，包括近期实践指南中强调的用于风险分层和治疗选择的信息，通过确保更一致地使用LVEF测量可能有更多改善结局的机会。然而，由于LVEF检测因患者特征而异，依赖部分临床进行的LVEF测量将导致MI后LV功能障碍患病率的估计存在偏差。
