Wierzbowska-Drabik Karina, Krzemińska-Pakula Maria, Drozdz Jarosław, Plewka Michał, Trzos Ewa, Kurpesa Malgorzata, Rechciński Tomasz, Rózga Aneta, Plońska-Gościniak Edyta, Kasprzak Jarosław D
II Chair and Department of Cardiology, Medical University of Lodz, Lodz, Poland.
Echocardiography. 2008 Jan;25(1):27-35. doi: 10.1111/j.1540-8175.2007.00553.x.
Patients after myocardial infarction (MI) differ according to the extend of myocardial damage and prognosis. Diastolic function impairment may have great impact on development of heart failure and outcomes. We evaluated the prognostic value of various echocardiographic measurements in 18-month and 3-year observation after MI.
60 patients after MI (44 male, mean age 60 +/- 11) were examined by transthoracic echocardiography with the assessment of wide spectrum of parameters. Mortality and combined end points (cardiac deaths and heart failure exacerbation) were assessed after 18-month and 3-year observation and groups with and without end points were compared. Optimal cutoff values were estimated by receiver operating characteristic (ROC) analysis and resulting Kaplan-Meier curves were compared.
After 18 months, 11 deaths occurred and 20 subjects experienced hospitalization caused by heart failure exacerbation. Although the group with cardiac events showed a greater enlargement of the left ventricle and lower ejection fraction, the highest relative risk of poor outcome (RR = 5.0) was related to the left atrial enlargement above 44 mm. Although restrictive or pseudonormal inflows were connected with 2.1 relative risk of combined end point, all patients with E deceleration time < or = 130 ms experienced heart failure exacerbation or death. Despite tissue Doppler and propagation parameters describing elevated end-diastolic pressure differed between groups with various outcomes in multivariate analysis, only enlarged left atrium was an independent predictor for both combined end point and cardiac death. Further 3-year follow-up solely confirmed the role of above described predictors.
心肌梗死（MI）后的患者因心肌损伤程度和预后不同而存在差异。舒张功能障碍可能对心力衰竭的发展及预后产生重大影响。我们评估了心肌梗死后18个月和3年观察期内各种超声心动图测量指标的预后价值。
对60例心肌梗死后患者（44例男性，平均年龄60±11岁）进行经胸超声心动图检查，评估一系列参数。在18个月和3年观察期后评估死亡率及复合终点（心源性死亡和心力衰竭加重），并比较有终点事件和无终点事件的组。通过受试者工作特征（ROC）分析估计最佳截断值，并比较所得的Kaplan-Meier曲线。
18个月后，发生11例死亡，20例因心力衰竭加重住院。虽然发生心脏事件的组左心室扩大更明显且射血分数更低，但预后不良的最高相对风险（RR = 5.0）与左心房扩大超过44 mm有关。虽然限制性或假性正常流入与复合终点的2.1相对风险相关，但所有E峰减速时间≤130 ms的患者均经历了心力衰竭加重或死亡。尽管在多变量分析中，描述舒张末期压力升高的组织多普勒和传播参数在不同预后组之间存在差异，但只有左心房扩大是复合终点和心源性死亡的独立预测因素。进一步的3年随访仅证实了上述预测因素的作用。
