The Heart Center of Chonnam National University Hospital, Korea Cardiovascular Stent Research Institute of Chonnam National University, Gwangju, Korea.
Korean Circ J. 2013 Nov;43(11):731-8. doi: 10.4070/kcj.2013.43.11.731. Epub 2013 Nov 30.
The purpose of this study is to identify the prevalence of progressive dilation in patients with acute myocardial infarction (AMI) combined with heart failure (HF) and determine the prognostic significance and associated factors with a geometric change of an infarcted heart.
A total of 1310 AMI patients with HF (63.9±12.5 years, 70% male) between November 2005 and April 2011 underwent echocardiography at admission and one year later. Left ventricular (LV) remodeling is defined as 20% progression, and left atria (LA) remodeling is 10% compared with the initial volume index.
The prevalence of both LA and LV remodeling was 13.9%; LV only was 9.3%, LA only 22.8% and non-remodeling was 55.1%, respectively. In the non-remodeling group, Killip class II was more frequent (83.9%, p<0.001) whereas in other remodeling groups, Killip class III was more frequent. Initial wall motion score index, ejection fraction, maximal cardiac enzyme, high sensitive C-reactive protein, B type natriuretic peptide, and triglyceride serum levels were significantly associated with heart remodeling. All causes of death occurred in 168 cases (12.8%) during the follow-up period. Mortality was the highest in the LV and LA remodeling group (20.9%) and the lowest in the non-remodeling group (11.4%). During the period of follow-up, the cumulative survival rate was significantly lower in the groups of LA and LV remodeling than in others (log rank p=0.006).
Total mortality was significantly increased in patients AMI with geometrically progressive LA and LV dilatation.
本研究旨在确定急性心肌梗死（AMI）合并心力衰竭（HF）患者进行性扩张的患病率，并确定与梗死心脏几何变化相关的预后意义和相关因素。
2005 年 11 月至 2011 年 4 月，共有 1310 例 AMI 合并 HF 患者（63.9±12.5 岁，70%为男性）在入院时和 1 年后接受了超声心动图检查。左心室（LV）重构定义为初始容积指数增加 20%，左心房（LA）重构定义为初始容积指数增加 10%。
LA 和 LV 重构的患病率分别为 13.9%、9.3%、22.8%和 55.1%。在无重构组中，Killip 心功能分级 II 级更为常见（83.9%，p<0.001），而在其他重构组中，Killip 心功能分级 III 级更为常见。初始壁运动评分指数、射血分数、最大心肌酶、高敏 C 反应蛋白、B 型利钠肽和甘油三酯血清水平与心脏重构显著相关。在随访期间，168 例（12.8%）患者发生全因死亡。LV 和 LA 重构组的死亡率最高（20.9%），无重构组的死亡率最低（11.4%）。在随访期间，LA 和 LV 重构组的累积生存率明显低于其他组（对数秩检验 p=0.006）。
在 AMI 患者中，LA 和 LV 几何扩张进行性增加与总死亡率显著增加相关。
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