Verma Anil, Meris Alessandra, Skali Hicham, Ghali Jalal K, Arnold J Malcolm O, Bourgoun Mikhail, Velazquez Eric J, McMurray John J V, Kober Lars, Pfeffer Marc A, Califf Robert M, Solomon Scott D
Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
JACC Cardiovasc Imaging. 2008 Sep;1(5):582-91. doi: 10.1016/j.jcmg.2008.05.012.
This study sought to understand prognostic implications of increased baseline left ventricular (LV) mass and geometric patterns in a high risk acute myocardial infarction.
The LV hypertrophy and alterations in LV geometry are associated with an increased risk of adverse cardiovascular events.
Quantitative echocardiographic analyses were performed at baseline in 603 patients from the VALIANT (VALsartan In Acute myocardial iNfarcTion) echocardiographic study. The left ventricular mass index (LVMi) and relative wall thickness (RWT) were calculated. Patients were classified into 4 mutually exclusive groups based on RWT and LVMi as follows: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), and concentric hypertrophy (increased LVMi and increased RWT). Cox proportional hazards models were used to evaluate the relationships among LVMi, RWT, LV geometry, and clinical outcomes.
Mean LVMi and RWT were 98.8 +/- 28.4 g/m(2) and 0.38 +/- 0.08. The risk of death or the composite end point of death from cardiovascular causes, reinfarction, heart failure, stroke, or resuscitation after cardiac arrest was lowest for patients with normal geometry, and increased with concentric remodeling (hazard ratio [HR]: 3.0; 95% confidence interval [CI]: 1.9 to 4.9), eccentric hypertrophy (HR: 3.1; 95% CI: 1.9 to 4.8), and concentric hypertrophy (HR: 5.4; 95% CI: 3.4 to 8.5), after adjusting for baseline covariates. Also, baseline LVMi and RWT were associated with increased mortality and nonfatal cardiovascular outcomes (HR: 1.22 per 10 g/m(2) increase in LVMi; 95% CI: 1.20 to 1.30; p < 0.001) (HR: 1.60 per 0.1-U increase in RWT; 95% CI: 1.30 to 1.90; p < 0.001). Increased risk associated with RWT was independent of LVMi.
Increased baseline LV mass and abnormal LV geometry portend an increased risk for morbidity and mortality following high-risk myocardial infarction. Concentric LV hypertrophy carries the greatest risk of adverse cardiovascular events including death. Higher RWT was associated with an increased risk of cardiovascular complications after high-risk myocardial infarction.
本研究旨在了解基线左心室（LV）质量增加和几何形态在高危急性心肌梗死中的预后意义。
LV肥厚和LV几何形态改变与不良心血管事件风险增加相关。
对来自VALIANT（缬沙坦治疗急性心肌梗死）超声心动图研究的603例患者在基线时进行定量超声心动图分析。计算左心室质量指数（LVMi）和相对壁厚度（RWT）。根据RWT和LVMi将患者分为4个相互排斥的组，如下：正常几何形态（正常LVMi和正常RWT）、向心性重构（正常LVMi和增加的RWT）、离心性肥厚（增加的LVMi和正常RWT）和向心性肥厚（增加的LVMi和增加的RWT）。使用Cox比例风险模型评估LVMi、RWT、LV几何形态与临床结局之间的关系。
平均LVMi和RWT分别为98.8±28.4 g/m²和0.38±0.08。几何形态正常的患者死亡或心血管原因死亡、再梗死、心力衰竭、中风或心脏骤停后复苏的复合终点风险最低，且随着向心性重构（风险比[HR]：3.0；95%置信区间[CI]：1.9至4.9）、离心性肥厚（HR：3.1；95%CI：1.9至4.8）和向心性肥厚（HR：5.4；95%CI：3.4至8.5）而增加，在调整基线协变量后。此外，基线LVMi和RWT与死亡率增加和非致命性心血管结局相关（LVMi每增加10 g/m²，HR：1.22；95%CI：1.20至1.30；p<0.001）（RWT每增加0.1个单位，HR：1.60；95%CI：1.30至1.90；p<0.001）。与RWT相关的风险增加独立于LVMi。
基线LV质量增加和LV几何形态异常预示着高危心肌梗死后发病和死亡风险增加。LV向心性肥厚发生包括死亡在内的不良心血管事件风险最高。较高的RWT与高危心肌梗死后心血管并发症风险增加相关。
