Kuch Marek, Janiszewski Maciej, Janiszewski Michał, Braksator Wojciech, Mamcarz Artur, Sadkowska Katarzyna, Kuch Jerzy, Dłuzniewski Mirosław
Akademia Medyczna w Warszawie, Katedra i Klinika Kardiologii II Wydziału Lekarskiego, Wojewódzki Szpital Bródnowski.
Pol Merkur Lekarski. 2006 Mar;20(117):285-8.
Prognosis in patients (pts) after myocardial infarction (MI) with chronic heart failure (CHF) and asymptomatic left ventricular dysfunction (ALVD) differs. Acute coronary syndromes (ACS) worsen CHF and prognosis in these pts. A diagnostic tool that identifies the group of high risk pts is needed. Prognostic factors include left ventricle ejection fraction (LVEF) and stage of heart failure. The aim of the study was evaluation if decreased LVEF worsen prognosis in pts with CHF and ALVD and whether LVEF is more powerful predictor of poor prognosis than severity of heart failure.
112 consecutive pts (95 men and 17 women age range 34-75, mean 52.9) post MI in stage B (ALVD) or stage C (CHF) according to ACC/AHA classification were studied. LVEF was determined in standard echocardiography with Simpson's method. Pts were divided into four groups: I--stage B and LVEF < or = 40% (6 pts); II--stage B and LVEF > 40% (52 pts); III--stage C and LVEF < or = 40% (19 pts); IV--stage C and LVEF > 40% (35 pts). The pts were followed for 30 months for the occurrence of the composite endpoint: major acute coronary events (MACE) i.e: ACS and cardiovascular deaths (CVD). In analysis we used chi2 test.
There were 35 MACE during follow-up: 30 in pts in stage C and 5 in stage B. There were more MACE in group I than in group III (p < 0.01) and in group II than in group IV (p < 0.001). Pts in group I had more MACE than in group IV (p < 0.05). There were more MACE in group II than in group III (p < 0.01). Other results were not statistically significant.
Stage of heart failure evaluated clinically is more powerful predictor of MACE than decreased LVEF. The more advanced stage of heart failure in post-MI pts, the higher risk of ACS or CVD. LVEF does not influence the risk of MACE in pts in the same stage of heart failure.
心肌梗死（MI）后合并慢性心力衰竭（CHF）和无症状左心室功能障碍（ALVD）的患者预后不同。急性冠状动脉综合征（ACS）会使这些患者的CHF和预后恶化。需要一种能够识别高危患者群体的诊断工具。预后因素包括左心室射血分数（LVEF）和心力衰竭阶段。本研究的目的是评估LVEF降低是否会使CHF和ALVD患者的预后恶化，以及LVEF是否比心力衰竭严重程度更能有力地预测不良预后。
根据ACC/AHA分类，对112例MI后处于B期（ALVD）或C期（CHF）的连续患者（95例男性和17例女性，年龄范围34 - 75岁，平均52.9岁）进行研究。采用辛普森法通过标准超声心动图测定LVEF。患者分为四组：I组——B期且LVEF≤40%（6例）；II组——B期且LVEF＞40%（52例）；III组——C期且LVEF≤40%（19例）；IV组——C期且LVEF＞40%（35例）。对患者进行30个月的随访，观察复合终点事件的发生情况：主要急性冠状动脉事件（MACE），即ACS和心血管死亡（CVD）。分析中使用卡方检验。
随访期间发生35例MACE：C期患者30例，B期患者5例。I组的MACE比III组多（p＜0.01），II组的MACE比IV组多（p＜0.001）。I组患者的MACE比IV组多（p＜0.05）。II组的MACE比III组多（p＜0.01）。其他结果无统计学意义。
临床评估的心力衰竭阶段比LVEF降低更能有力地预测MACE。MI后患者心力衰竭阶段越 advanced，发生ACS或CVD的风险越高。在心力衰竭相同阶段的患者中，LVEF不影响MACE风险。 （注：“advanced”此处结合语境推测可能是“更严重、更晚期”之意，因原文可能有误，暂按此翻译）
