Division of Cardiology, University of Maryland Medical Center, Baltimore, MD, USA.
Am J Cardiol. 2011 Jun 1;107(11):1667-74. doi: 10.1016/j.amjcard.2011.01.051.
Although asymptomatic left ventricular (LV) systolic dysfunction (ALVSD) is common, its phenotype and prognosis for incident heart failure (HF) and mortality are insufficiently understood. Echocardiography was done in 5,649 participants in the Cardiovascular Health Study (age 73.0 ± 5.6 years, 57.6% women). The clinical characteristics and cardiovascular risk factors of the participants with ALVSD were compared to those with normal LV function (ejection fraction ≥55%) and with symptomatic LV systolic dysfunction (SLVSD; ejection fraction <55% and a history of HF). Cox proportional hazards models were used to estimate the risk of incident HF and mortality in those with ALVSD. Also, comparisons were made among the LV ejection fraction subgroups using previously validated cutoff values (<45% and 45% to 55%), adjusting for the demographic and cardiovascular disease risk factors. Those with ALVSD (7.3%) were more likely to have cardiovascular risk factors than those in the reference group (without LV dysfunction or symptomatic HF) but less likely than those with SLVSD. The HF rate was 24 occurrences per 1,000 person-years in the reference group and 57 occurrences per 1,000 person-years in those with ALVSD. The HF rate was 45 occurrences per 1,000 person-years for those with ALVSD and mildly impaired LV dysfunction and 93 occurrences per 1,000 person-years for those with ALVSD and moderate to severe LV dysfunction. The mortality rate was 51 deaths per 1,000 person-years in the reference group, 90 deaths per 1,000 person-years in the ALVSD group, and 156 deaths per 1,000 person-years in the SLVSD group. Adjusting for covariates, compared to the reference group, ALVSD was associated with an increased risk of incident HF (hazard ratio 1.60, 95% confidence interval 1.35 to 1.91), cardiovascular mortality (hazard ratio 2.13, 95% confidence interval 1.81 to 2.51), and all-cause mortality (hazard ratio 1.46, 95% confidence interval 1.29 to 1.64). In conclusion, subjects with ALVSD are characterized by a greater prevalence of cardiovascular risk factors and co-morbidities than those with normal LV function and without HF. However, the prevalence is lower than in those with SLVSD. Patients with ALVSD are at an increased risk of HF and mortality, particularly those with greater severity of LV impairment.
虽然无症状左心室（LV）收缩功能障碍（ALVSD）很常见，但它的表型以及发生心力衰竭（HF）和死亡的预后尚不清楚。在心血管健康研究（年龄 73.0±5.6 岁，57.6%为女性）的 5649 名参与者中进行了超声心动图检查。将 ALVSD 患者的临床特征和心血管危险因素与具有正常 LV 功能（射血分数≥55%）和有症状 LV 收缩功能障碍（SLVSD；射血分数<55%和有 HF 病史）的患者进行比较。使用 Cox 比例风险模型来估计 ALVSD 患者发生 HF 和死亡的风险。此外，还使用以前验证的截断值（<45%和 45%至 55%）在 LV 射血分数亚组之间进行比较，同时调整了人口统计学和心血管疾病危险因素。与参考组（无 LV 功能障碍或有症状 HF）相比，ALVSD 患者更有可能存在心血管危险因素，但比 SLVSD 患者的可能性小。参考组的 HF 发生率为每 1000 人年 24 例，ALVSD 患者为每 1000 人年 57 例。ALVSD 患者中，轻度 LV 功能障碍的 HF 发生率为每 1000 人年 45 例，中度至重度 LV 功能障碍的 HF 发生率为每 1000 人年 93 例。参考组的死亡率为每 1000 人年 51 例死亡，ALVSD 组为每 1000 人年 90 例死亡，SLVSD 组为每 1000 人年 156 例死亡。调整协变量后，与参考组相比，ALVSD 与 HF 事件风险增加相关（风险比 1.60，95%置信区间 1.35 至 1.91）、心血管死亡率（风险比 2.13，95%置信区间 1.81 至 2.51）和全因死亡率（风险比 1.46，95%置信区间 1.29 至 1.64）。总之，与正常 LV 功能且无 HF 的患者相比，ALVSD 患者的心血管危险因素和合并症更为常见。然而，其患病率低于 SLVSD 患者。ALVSD 患者发生 HF 和死亡的风险增加，尤其是那些 LV 损伤程度更严重的患者。
