Møller Jacob E, Hillis Graham S, Oh Jae K, Reeder Guy S, Gersh Bernard J, Pellikka Patricia A
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
Am Heart J. 2006 Feb;151(2):419-25. doi: 10.1016/j.ahj.2005.03.042.
The prognostic importance of regional systolic function, as assessed by wall motion score index (WMSI), compared with global function, as assessed by left ventricular ejection fraction (LVEF), has not been assessed in large populations after acute myocardial infarction.
Echocardiograms, including the assessment of WMSI and LVEF, were performed in 767 patients with acute myocardial infarction at a median of 1 day (25th and 75th percentiles 0-2 days) after admission. Patients were followed for a median of 19 months (range 12-28 months). Cox proportional hazards models were constructed for the primary study end point (all-cause mortality) and for a secondary end point (hospitalization for congestive heart failure).
During follow-up (median 40 months; range 32-50 months), 216 patients died and 54 patients were hospitalized for congestive heart failure. By univariate analysis, both LVEF (P < .0001) and WMSI (P < .0001) were powerful predictors of all-cause mortality. By a forward conditional Cox model, WMSI proved to be an independent predictor of death (hazard ratio 1.15 per 0.2-unit increase, 95% CI 1.10-1.21, P < .0001). When WMSI was included in the model, LVEF did not provide additional prognostic information (P = .77). Wall motion score index also proved to be an independent predictor of hospitalization for congestive heart failure (hazard ratio 1.21 per 0.2-unit increase, 95% CI 1.07-1.37, P = .002), whereas LVEF did not (P = .56).
Both LVEF and WMSI provide powerful prognostic information after acute myocardial infarction; however, the predictive power of WMSI is greater.
急性心肌梗死后，在大量人群中尚未评估通过室壁运动评分指数（WMSI）评估的局部收缩功能与通过左心室射血分数（LVEF）评估的整体功能相比，其对预后的重要性。
对767例急性心肌梗死患者在入院后中位时间1天（第25和第75百分位数为0 - 2天）进行了超声心动图检查，包括WMSI和LVEF评估。患者随访中位时间为19个月（范围12 - 28个月）。构建Cox比例风险模型用于主要研究终点（全因死亡率）和次要终点（因充血性心力衰竭住院）。
在随访期间（中位时间40个月；范围32 - 50个月），216例患者死亡，54例患者因充血性心力衰竭住院。单因素分析显示，LVEF（P <.0001）和WMSI（P <.0001）均为全因死亡率的有力预测指标。通过向前条件Cox模型，WMSI被证明是死亡的独立预测指标（每增加0.2单位，风险比为1.15，95%置信区间为1.10 - 1.21，P <.0001）。当WMSI纳入模型时，LVEF未提供额外的预后信息（P =.77）。室壁运动评分指数也被证明是因充血性心力衰竭住院的独立预测指标（每增加0.2单位，风险比为1.21，95%置信区间为1.07 - 1.37，P =.002），而LVEF则不是（P =.56）。
急性心肌梗死后，LVEF和WMSI均提供有力的预后信息；然而，WMSI的预测能力更强。
