利用二尖瓣 E/A 比值联合 e 波减速时间预测冠心病门诊患者心力衰竭和不良心血管事件：心脏与心灵研究。

Prediction of heart failure and adverse cardiovascular events in outpatients with coronary artery disease using mitral E/A ratio in conjunction with e-wave deceleration time: the heart and soul study.

机构信息

Department of Medicine, Veterans Affairs Medical Center, San Francisco, California; Department of Medicine, University of California, San Francisco, San Francisco, California.

出版信息

J Am Soc Echocardiogr. 2011 Oct;24(10):1134-40. doi: 10.1016/j.echo.2011.06.003. Epub 2011 Jul 18.

DOI:10.1016/j.echo.2011.06.003

PMID:21764551

Abstract

BACKGROUND

Deceleration time (DT) of early mitral inflow (E) is a marker of diastolic left ventricular (LV) chamber stiffness that is routinely measured during the quantitation of LV diastolic function with Doppler echocardiography. Shortened DT after myocardial infarction predicts worse cardiovascular outcome. Recent studies have shown that indexing DT to peak E-wave velocity (pE) augments its prognostic power in a population with a high prevalence of coronary risk factors and in patients with hypertension during antihypertensive treatment. However, in ambulatory subjects with stable coronary artery disease (CAD), it is not known whether DT predicts cardiovascular events and whether DT/pE improves its prognostic power.

METHODS

The ability of DT and DT/pE to predict heart failure (HF) hospitalizations and other major adverse cardiovascular events (MACEs) was studied prospectively in 926 ambulatory patients with stable CAD enrolled in the Heart and Soul Study. Unadjusted and multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for HF and other MACEs.

RESULTS

During a mean of 6.3 ± 2.0 years, there were 124 hospitalizations for HF and 198 other MACEs. Relative to participants with mitral E/A ratios in the normal range (0.75 < E/A < 1.5; n = 604), those with E/A ratios ≥ 1.5 (n = 107) had an increased risk for HF (HR, 2.54; 95% CI, 1.52-4.25, P < .001) but not for other MACEs (HR, 1.00; 95% CI, 0.60-1.68; P = 1.00), while those with E/A ratios ≤ 0.75 (n = 215) were not at increased risk for either outcome. Among patients with normal E/A ratios, lower DT/pE predicted HF (HR, 0.47; 95% CI, 0.23-0.97, P = .04 per point increase in ln{msec/[cm/sec]}), while DT alone did not. However, in this group with normal E/A ratios, neither DT/pE nor DT alone was predictive of other MACEs. In patients with E/A ratios ≤ 0.75 (n = 215) and those with E/A ratios ≥ 1.5 (n = 107), neither DT nor DT/pE predicted either end point.

CONCLUSIONS

In ambulatory patients with stable CAD, restrictive filling (E/A ratio ≥ 1.5) is a powerful predictor of HF. Among those with normal mitral E/A ratios (0.75-1.5), only DT/pE predicts HF, while neither DT nor DT/pE predicts other MACEs. This suggests that mitral E/A ratio has significant prognostic value in patients with CAD, and in those with normal mitral E/A ratios, the normalization of DT to pE augments its prognostic power.

摘要

背景

早期二尖瓣流入（E）的减速时间（DT）是左心室（LV）腔僵硬度的舒张标志物，在使用多普勒超声心动图定量评估 LV 舒张功能时常规测量。心肌梗死后 DT 缩短预示着心血管结局较差。最近的研究表明，在具有高冠心病风险因素的人群中和在接受降压治疗的高血压患者中，将 DT 指数化到峰值 E 波速度（pE）可增强其预后能力。然而，在患有稳定型冠状动脉疾病（CAD）的门诊患者中，尚不清楚 DT 是否可预测心血管事件，以及 DT/pE 是否可改善其预后能力。

方法

前瞻性研究了 926 例在 Heart and Soul 研究中患有稳定型 CAD 的门诊患者，使用 DT 和 DT/pE 预测心力衰竭（HF）住院和其他主要不良心血管事件（MACE）的能力。计算了 HF 和其他 MACE 的未调整和多变量调整的危险比（HR）和 95%置信区间（CI）。

结果

在平均 6.3±2.0 年的随访中，有 124 例 HF 住院和 198 例其他 MACE。与二尖瓣 E/A 比值正常范围（0.75<E/A<1.5；n=604）的参与者相比，E/A 比值≥1.5（n=107）的患者 HF 风险增加（HR，2.54；95%CI，1.52-4.25，P<.001），但其他 MACE 风险无增加（HR，1.00；95%CI，0.60-1.68；P=1.00），而 E/A 比值≤0.75（n=215）的患者HF 或其他 MACE 风险均无增加。在 E/A 比值正常的患者中，较低的 DT/pE 预测 HF（HR，0.47；95%CI，0.23-0.97，P=.04 每增加 ln{msec/[cm/sec]}），而 DT 单独则不能。然而，在这组 E/A 比值正常的患者中，DT/pE 和 DT 单独均不能预测其他 MACE。在 E/A 比值≤0.75（n=215）和 E/A 比值≥1.5（n=107）的患者中，DT 或 DT/pE 均不能预测任何终点。

结论

在患有稳定型 CAD 的门诊患者中，限制性充盈（E/A 比值≥1.5）是 HF 的有力预测指标。在二尖瓣 E/A 比值正常的患者中（0.75-1.5），只有 DT/pE 预测 HF，而 DT 或 DT/pE 均不能预测其他 MACE。这表明二尖瓣 E/A 比值在 CAD 患者中有重要的预后价值，在二尖瓣 E/A 比值正常的患者中，DT 到 pE 的归一化可增强其预后能力。