Naqvi Tasneem Z, Padmanabhan Sriram, Rafii Farhad, Hyuhn Hahn K, Mirocha James
The Cedars-Sinai Medical Center, University of California Los Angeles School of Medicine, Los Angeles, California, USA.
Am J Cardiol. 2006 Jan 15;97(2):160-6. doi: 10.1016/j.amjcard.2005.08.022. Epub 2005 Nov 17.
Left ventricular (LV) diastolic function is an important predictor of morbidity and mortality after acute myocardial infarction (AMI). We evaluated the role of diastolic function in predicting in-hospital events and LV ejection fraction (EF) 6 months after a first AMI that was treated with primary percutaneous coronary intervention (PCI). We prospectively enrolled 59 consecutive patients who were 60 +/- 15 years of age (48 men), presented at our institution with their first AMI, and were treated with primary PCI. Patients underwent 2-dimensional and Doppler echocardiography, including tissue Doppler imaging of 6 basal mitral annular regions within 24 hours after primary PCI and were followed until discharge. Clinical and echocardiographic variables at index AMI were compared with a combined end point of cardiac death, ventricular tachycardia, congestive heart failure, or emergency in-hospital surgical revascularization. Follow-up echocardiographic assessment was performed at 6 months in 24 patients. During hospitalization, 3 patients died, 7 developed congestive heart failure, 4 had ventricular tachycardia, and 1 required emergency surgical revascularization. Stepwise logistic regression analysis showed the ratio of early mitral inflow diastolic filling wave (E) to peak early diastolic velocity of non-infarct-related mitral annulus (p < 0.01) (E') and mitral inflow E-wave deceleration time (p < 0.02) to be independent predictors of in-hospital cardiac events (generalized R2 = 0.66). In a stepwise multiple linear regression model, independent predictors of follow-up LVEF were mitral inflow deceleration time (R2 = 0.39, p = 0.002), baseline LVEF (R2 = 0.54, p < 0.02), and mitral inflow peak early velocity/mitral annular peak early velocity (or E/E') of infarct annulus (R2 = 0.66, p = 0.02). In conclusion, in patients who are treated with primary PCI for a first AMI, E/E' velocity ratio and mitral inflow E-wave deceleration time are strong predictors of in-hospital cardiac events and of LVEF at 6-month follow-up.
左心室舒张功能是急性心肌梗死（AMI）后发病率和死亡率的重要预测指标。我们评估了舒张功能在预测首次接受直接经皮冠状动脉介入治疗（PCI）的AMI患者住院期间事件及6个月后左心室射血分数（EF）方面的作用。我们前瞻性纳入了59例连续患者，年龄为60±15岁（48例男性），因首次AMI就诊于我院并接受直接PCI治疗。患者在直接PCI后24小时内接受二维和多普勒超声心动图检查，包括对6个二尖瓣环基底部区域进行组织多普勒成像，并随访至出院。将首次AMI时的临床和超声心动图变量与心脏死亡、室性心动过速、充血性心力衰竭或住院期间急诊外科血管重建的联合终点进行比较。对24例患者在6个月时进行了随访超声心动图评估。住院期间，3例患者死亡，7例发生充血性心力衰竭，4例出现室性心动过速，1例需要急诊外科血管重建。逐步逻辑回归分析显示，早期二尖瓣舒张期血流充盈波（E）与非梗死相关二尖瓣环舒张早期峰值速度（p<0.01）（E'）的比值以及二尖瓣血流E波减速时间（p<0.02）是住院期间心脏事件的独立预测指标（广义R2 = 0.66）。在逐步多元线性回归模型中，随访左心室射血分数的独立预测指标为二尖瓣血流减速时间（R2 = 0.39，p = 0.002）、基线左心室射血分数（R2 = 0.54，p<0.02）以及梗死二尖瓣环的二尖瓣血流早期峰值速度/二尖瓣环早期峰值速度（或E/E'）（R2 = 0.66，p = 0.02）。总之，对于首次AMI接受直接PCI治疗的患者，E/E'速度比值和二尖瓣血流E波减速时间是住院期间心脏事件以及6个月随访时左心室射血分数的有力预测指标。
