Mateus Pedro S, Dias Carla Costa, Betrencourt Nuno, Adão Luís, Santos Lino, Sampaio Francisco, Mateus Carlos, Primo João, Simões Lino, Barros Henrique, Ribeiro Vasco Gama
Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal.
Rev Port Cardiol. 2005 May;24(5):727-34.
Left ventricular (LV) systolic function is an important prognostic factor in coronary heart disease. Left ventricular ejection fraction (LVEF) should be assessed in all patients after acute myocardial infarction (AMI). Although reperfusion therapy has been found effective in the reduction of complications of AMI, LVEF impairment is a common consequence of an acute coronary event. The aim of this study was to estimate the incidence of LVEF depression after ST-elevation myocardial infarction (STEMI) and to evaluate the effect of previous cardiovascular risk factors on the risk of LV dysfunction.
One hundred and forty-seven consecutive patients with a first STEMI were included in this study. Most patients were male (70.7%) and mean age was 60.7 years. LVEF was assessed by echocardiography (using the single-plane area-length method and automatic border detection). LV systolic function was considered depressed when ejection fraction was less than 45 %. The chi-square test was used in the statistical analysis to compare proportions and a logistic regression model was fitted to assess the independent effect of each variable.
Incidence of LV dysfunction was 55.8% in STEMI patients. No association was found between gender or age and LVEF impairment. The proportion of patients with diabetes was higher in the impaired LVEF group than in normal LVEF patients (44.7% vs. 31.7%, p = 0.12); the prevalence of smoking was also higher in patients with LV dysfunction (46.9% vs. 33.8%, p = 0.11). On the other hand, dyslipidemia was less common in patients with depressed LV function (35.4% vs. 56.9%, p = 0.01). Hypertension was not associated with impaired LVEF. After adjustment for ST-elevation location and number of vessels with critical stenosis, diabetes and smoking were associated with a significantly higher risk of LVEF impairment (diabetes: OR = 3.73, 95% CI 1.25-11.16; smoking: OR = 3.9, 95% CI 1.37-11.07) and dyslipidemia with a significantly lower risk of LV dysfunction (OR: 0.37, 95% CI 0.15-0.88).
In STEMI patients, previous cardiovascular risk factors have a significant impact on the likelihood of LV dysfunction and hence could influence long-term prognosis.
左心室（LV）收缩功能是冠心病的一个重要预后因素。急性心肌梗死（AMI）后所有患者均应评估左心室射血分数（LVEF）。尽管再灌注治疗已被证明可有效降低AMI的并发症，但LVEF受损是急性冠状动脉事件的常见后果。本研究的目的是估计ST段抬高型心肌梗死（STEMI）后LVEF降低的发生率，并评估既往心血管危险因素对左心室功能障碍风险的影响。
本研究纳入了147例连续的首次发生STEMI的患者。大多数患者为男性（70.7%），平均年龄为60.7岁。通过超声心动图（使用单平面面积-长度法和自动边界检测）评估LVEF。当射血分数小于45%时，认为左心室收缩功能受损。采用卡方检验进行统计分析以比较比例，并拟合逻辑回归模型以评估每个变量的独立作用。
STEMI患者左心室功能障碍的发生率为55.8%。未发现性别或年龄与LVEF受损之间存在关联。LVEF受损组糖尿病患者的比例高于LVEF正常患者（44.7%对31.7%，p = 0.12）；左心室功能障碍患者的吸烟率也较高（46.9%对33.8%，p = 0.11）。另一方面，左心室功能降低的患者血脂异常较少见（35.4%对56.9%，p = 0.01）。高血压与LVEF受损无关。在调整ST段抬高部位和严重狭窄血管数量后，糖尿病和吸烟与LVEF受损风险显著升高相关（糖尿病：OR = 3.73，95%CI 1.25 - 11.16；吸烟：OR = 3.9，95%CI 1.37 - 11.07），而血脂异常与左心室功能障碍风险显著降低相关（OR：0.37，95%CI 0.15 - 0.88）。
在STEMI患者中，既往心血管危险因素对左心室功能障碍的可能性有显著影响，因此可能影响长期预后。
