Quintana Miguel, Edner Magnus, Kahan Thomas, Hjemdahl Paul, Sollevi Alf, Rehnqvist Nina
Department of Cardiology, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
Int J Cardiol. 2004 Aug;96(2):183-9. doi: 10.1016/j.ijcard.2004.05.006.
In addition to clinical risk markers, indices of left ventricular (LV) systolic function are valuable prognostic markers after acute myocardial infarction (MI). Previous studies have also suggested that LV diastolic function may contribute with prognostic information. The present study assessed whether this assumption applies to a large population of patients with acute MI who underwent thrombolytic therapy.
520 out of 608 patients participating in the ATTenuation by Adenosine of Cardiac Complications (ATTACC) study, with an ST-elevation acute MI underwent two-dimensional and Doppler echocardiographic examination at 4 (range 2-10) days after admission. During the follow-up period of 31 (S.D. +/- 11) months, cardiovascular death occurred in 57 (11%) patients, nonfatal acute MI occurred in 77 (15%), and 124 (24%) patients suffered a combined cardiovascular end-point (either nonfatal acute MI or cardiovascular death). Univariate regression analysis showed that all indices of LV systolic function predicted cardiovascular death and combined cardiovascular end-points. Regarding LV diastolic function only a restrictive filling pattern predicted cardiovascular death. In a multistep multivariate regression analysis in which the variables were introduced in a hierarchic order age, history of systemic hypertension, wall motion score index (WMSi), and history of previous MI and diabetes mellitus were independent predictors of cardiovascular death. A history of systemic hypertension or congestive heart failure were independent predictors of nonfatal acute MI, while a history of systemic hypertension, wall motion score index and diabetes mellitus independently predicted combined cardiovascular end-points.
The results of this study confirmed that clinical risk indicators and LV systolic function were the most important independent predictors of cardiovascular death and combined cardiovascular end-points. LV diastolic function assessed by Doppler-echocardiography did not provide additional prognostic information.
除临床风险标志物外，左心室（LV）收缩功能指标是急性心肌梗死（MI）后有价值的预后标志物。既往研究还提示LV舒张功能可能提供预后信息。本研究评估这一假设是否适用于接受溶栓治疗的大量急性MI患者。
参与心脏并发症腺苷衰减（ATTACC）研究的608例患者中，520例ST段抬高型急性MI患者在入院后4（范围2 - 10）天接受二维和多普勒超声心动图检查。在31（标准差±11）个月的随访期内，57例（11%）患者发生心血管死亡，77例（15%）发生非致死性急性MI，124例（24%）患者发生心血管复合终点事件（非致死性急性MI或心血管死亡）。单因素回归分析显示，LV收缩功能的所有指标均能预测心血管死亡和心血管复合终点事件。关于LV舒张功能，仅限制性充盈模式可预测心血管死亡。在多步骤多因素回归分析中，按层次顺序引入变量，年龄、系统性高血压病史、室壁运动评分指数（WMSi）、既往MI病史和糖尿病是心血管死亡的独立预测因素。系统性高血压或充血性心力衰竭病史是非致死性急性MI的独立预测因素，而系统性高血压病史、室壁运动评分指数和糖尿病独立预测心血管复合终点事件。
本研究结果证实，临床风险指标和LV收缩功能是心血管死亡和心血管复合终点事件最重要的独立预测因素。多普勒超声心动图评估的LV舒张功能未提供额外的预后信息。
