Kelly T L, Cremo R, Nielsen C, Shabetai R
Cardiovascular Section, San Diego Veterans Administration Medical Center, CA 92161.
Am Heart J. 1990 May;119(5):1111-21. doi: 10.1016/s0002-8703(05)80242-x.
One hundred thirty-three patients with dilated heart failure, 80 with coronary artery disease, and 53 with idiopathic dilated cardiomyopathy were followed for a mean of 29 months. Patients with ischemic heart disease had a worse prognosis than those classified as having idiopathic cardiomyopathy. Features from history, physical examination, and diagnostic tests done when patients were referred to our clinic were checked for univariate association with survival and were used in Cox model survival analysis to define risk groups. Neither the overall group nor either subgroup showed a relationship between ejection fraction and survival. The best variables for predicting long-term mortality included underlying coronary artery disease, basal systolic blood pressure of less than 120 mm Hg, presence of congestion on chest radiogram, and age over 64. Other variables did not improve risk prediction in the overall group. Among patients with ischemic heart disease, blood pressure, congestion, maximal heart rate on treadmill test, and the presence of left bundle branch block on the initial electrocardiogram all contributed. Only systolic blood pressure and the symptom score were related to survival in idiopathic cardiomyopathy.
133例扩张型心力衰竭患者、80例冠状动脉疾病患者和53例特发性扩张型心肌病患者平均随访29个月。缺血性心脏病患者的预后比归类为特发性心肌病的患者更差。对患者转诊至我们诊所时的病史、体格检查和诊断检查结果进行检查，以确定其与生存率的单变量关联，并用于Cox模型生存分析以定义风险组。总体组和任何一个亚组中，射血分数与生存率之间均无关联。预测长期死亡率的最佳变量包括潜在的冠状动脉疾病、基础收缩压低于120 mmHg、胸部X线片显示有充血以及年龄超过64岁。其他变量并未改善总体组的风险预测。在缺血性心脏病患者中，血压、充血情况、跑步机试验时的最大心率以及初始心电图上左束支传导阻滞的存在均有影响。在特发性心肌病中，只有收缩压和症状评分与生存率相关。
