多巴酚丁胺负荷超声心动图检查期间运动不能转变为运动障碍的预后意义

Prognostic significance of akinesis becoming dyskinesis during dobutamine stress echocardiography.

作者信息

Sozzi Fabiola B, Elhendy Abdou, Rizzello Vittoria, Biagini Elena, van Domburg Ron T, Vourvouri Eleni C, Schinkel Arend F L, Danzi Gian Battista, Bax Jeroen J, Poldermans Don

机构信息

Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands.

出版信息

J Am Soc Echocardiogr. 2007 Mar;20(3):257-61. doi: 10.1016/j.echo.2006.08.043.

DOI:10.1016/j.echo.2006.08.043

PMID:17336751

Abstract

BACKGROUND

Akinesis becoming dyskinesis (AKBD) at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, its prognostic significance is unknown.

OBJECTIVES

We sought to assess the long-term outcome of patients with AKBD during DSE.

METHODS

A total of 731 patients (age 62 +/- 15 years, 628 men) with two or more akinetic left ventricular segments at rest underwent DSE and were followed up for a mean period of 5 +/- 2.7 years. The end points considered during follow-up were hard cardiac events (cardiac death and nonfatal myocardial infarction) and heart failure.

RESULTS

Dyskinesis in two or more segments at peak stress developed in 60 patients (8%). Resting wall-motion score index was 2.6 +/- 0.56 in patients with AKBD versus 2.3 +/- 0.55 in patients without AKBD (P = .0002). Ischemia occurred in 197 patients (27%). During follow-up, 254 patients (35%) developed hard cardiac events and 204 patients (28%) developed heart failure. In all, 226 patients (31%) died of various causes (cardiac death in 172 patients). The annualized hard cardiac event rate was 11% in patients with AKBD and 6% in patients without (P = .03). The incidence of heart failure was significantly higher in patients with AKBD than without (47% vs 26%, P < .001). Independent predictors of hard cardiac events were age (hazard ratio [HR] 1.03 [confidence interval {CI} = 1.01-1.04]), previous myocardial infarction (HR 1.4 [CI = 1.1-1.9]), diabetes mellitus (HR 1.8 [CI = 1.3-2.5]), resting wall-motion score index (HR 1.11 [CI = 1.01-1.04]), and AKBD (HR 1.6 [CI = 1.1-2.4]).

CONCLUSION

AKBD at peak DSE is associated with increased risk of cardiac events in patients with akinetic segments at baseline echocardiogram.

摘要

背景

在高剂量多巴酚丁胺负荷超声心动图（DSE）检查中，运动不能转变为运动障碍（AKBD）一直未被视为心肌缺血的标志物。然而，其预后意义尚不清楚。

目的

我们试图评估DSE检查时发生AKBD的患者的长期预后。

方法

共有731例静息时存在两个或更多左心室运动不能节段的患者接受了DSE检查，并进行了平均5±2.7年的随访。随访期间考虑的终点事件为严重心脏事件（心源性死亡和非致死性心肌梗死）和心力衰竭。

结果

60例患者（8%）在负荷高峰时出现两个或更多节段的运动障碍。AKBD患者静息壁运动评分指数为2.6±0.56，无AKBD患者为2.3±0.55（P = 0.0002）。197例患者（27%）出现心肌缺血。随访期间，254例患者（35%）发生严重心脏事件，204例患者（28%）发生心力衰竭。共有226例患者（31%）死于各种原因（172例心源性死亡）。AKBD患者的年化严重心脏事件发生率为11%，无AKBD患者为6%（P = 0.03）。AKBD患者的心力衰竭发生率显著高于无AKBD患者（47%对26%，P < 0.001）。严重心脏事件的独立预测因素为年龄（风险比[HR] 1.03 [置信区间{CI}=1.01 - 1.04]）、既往心肌梗死（HR 　1.4 [CI = 1.1 - 1.9]）、糖尿病（HR 1.8 [CI = 1.3 - 2.5]）、静息壁运动评分指数（HR 1.11 [CI = 1.01 - 1.04]）和AKBD（HR 1.6 [CI = 1.1 - 2.4]）。