Shahar Keren, Darawsha Wisam, Yalonetsky Sergey, Lessick Jonathan, Kapeliovich Michael, Dragu Robert, Mutlak Diab, Reisner Shimon, Agmon Yoram, Aronson Doron
Department of Cardiology, Rambam Medical Center and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Department of Cardiology, Rambam Medical Center and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
J Am Heart Assoc. 2016 Jul 11;5(7):e003606. doi: 10.1161/JAHA.116.003606.
The clinical importance of right ventricular (RV) function in acute myocardial infarction is well recognized, but the impact of concomitant pulmonary hypertension (PH) has not been studied.
We studied 1044 patients with acute myocardial infarction. Patients were classified into 4 groups according to the presence or absence of RV dysfunction and PH, defined as pulmonary artery systolic pressure >35 mm Hg: normal right ventricle without PH (n=509), normal right ventricle and PH (n=373), RV dysfunction without PH (n=64), and RV dysfunction and PH (n=98). A landmark analysis of early (admission to 30 days) and late (31 days to 8 years) mortality and readmission for heart failure was performed. In the first 30 days, RV dysfunction without PH was associated with a high mortality risk (adjusted hazard ratio 5.56, 95% CI 2.05-15.09, P<0.0001 compared with normal RV and no PH). In contrast, after 30 days, mortality rates among patients with RV dysfunction were increased only when PH was also present. Compared with patients having neither RV dysfunction nor PH, the adjusted hazard ratio for mortality was 1.44 (95% CI 0.68-3.04, P=0.34) in RV dysfunction without PH and 2.52 (95% CI 1.64-3.87, P<0.0001) in RV dysfunction with PH. PH with or without RV dysfunction was associated with increased risk for heart failure.
In the absence of elevated pulmonary pressures, the risk associated with RV dysfunction after acute myocardial infarction is entirely confined to the first 30 days. Beyond 30 days, PH is the stronger risk factor for long-term mortality and readmission for heart failure.
右心室（RV）功能在急性心肌梗死中的临床重要性已得到充分认识，但合并肺动脉高压（PH）的影响尚未得到研究。
我们研究了1044例急性心肌梗死患者。根据有无RV功能障碍和PH将患者分为4组，PH定义为肺动脉收缩压>35 mmHg：无PH的正常右心室（n = 509）、有PH的正常右心室（n = 373）、无PH的RV功能障碍（n = 64）和有PH的RV功能障碍（n = 98）。对早期（入院至30天）和晚期（31天至8年）死亡率以及因心力衰竭再次入院进行了标志性分析。在最初30天内，无PH的RV功能障碍与高死亡风险相关（调整后的风险比为5.56，95%可信区间为2.05 - 15.09，与无PH的正常RV相比，P<0.0001）。相比之下，30天后，仅当合并PH时，RV功能障碍患者的死亡率才会增加。与既无RV功能障碍也无PH的患者相比，无PH的RV功能障碍患者的调整后死亡风险比为1.44（95%可信区间为0.68 - 3.04，P = 0.34），有PH的RV功能障碍患者为2.52（95%可信区间为1.64 - 3.87，P<0.0001）。有或无RV功能障碍的PH均与心力衰竭风险增加相关。
在肺动脉压力未升高的情况下，急性心肌梗死后与RV功能障碍相关的风险完全局限于最初30天。30天后，PH是长期死亡率和因心力衰竭再次入院的更强风险因素。
