Gradman A, Deedwania P, Cody R, Massie B, Packer M, Pitt B, Goldstein S
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06510.
J Am Coll Cardiol. 1989 Sep;14(3):564-70; discussion 571-2. doi: 10.1016/0735-1097(89)90093-4.
The relation between baseline clinical variables and subsequent mortality was examined in 295 patients with mild to moderate heart failure who participated in a multicenter trial comparing the effect on treadmill exercise tolerance of captopril, digoxin and placebo given in addition to a diuretic drug. At baseline study, all patients had a left ventricular ejection fraction less than or equal to 40%; 81% were in New York Heart Association functional class II. The etiology of heart failure was ischemic in 62% and nonischemic in 38%. During an average follow-up period of 16 months, 47 patients (16%) died and 24 deaths were classified as sudden. By univariate analysis, left ventricular ejection fraction, ventricular premature beat frequency, couplet frequency, ventricular tachycardia frequency, functional class, treadmill exercise time and nonischemic heart disease were statistically associated with mortality. With multiple logistic regression analysis, left ventricular ejection fraction was identified as the variable most closely associated with total mortality (p = 0.006). Twenty-seven percent of patients with an ejection fraction less than or equal to 20% died compared with 7% with an ejection fraction greater than or equal to 30%. Ventricular tachycardia frequency on Holter monitoring was independently associated with both total mortality (p = 0.008) and sudden death (p = 0.003). Patients with a ventricular tachycardia frequency of greater than 0.088 events/h had a mortality rate of 34% compared with 12% in those without ventricular tachycardia. In the multivariate model, functional class (p = 0.02) and etiology of nonischemic heart disease (p = 0.04) remained as independent predictors of mortality, whereas treadmill exercise duration did not.(ABSTRACT TRUNCATED AT 250 WORDS)
在295例轻至中度心力衰竭患者中，研究了基线临床变量与后续死亡率之间的关系。这些患者参与了一项多中心试验，该试验比较了卡托普利、地高辛及安慰剂加利尿剂对跑步机运动耐量的影响。在基线研究时，所有患者的左心室射血分数均小于或等于40%；81%处于纽约心脏协会功能分级II级。心力衰竭的病因中，缺血性的占62%，非缺血性的占38%。在平均16个月的随访期内，47例患者（16%）死亡，24例死亡被归类为猝死。单因素分析显示，左心室射血分数、室性早搏频率、成对早搏频率、室性心动过速频率、功能分级、跑步机运动时间及非缺血性心脏病与死亡率在统计学上相关。多因素逻辑回归分析确定左心室射血分数是与总死亡率最密切相关的变量（p = 0.006）。射血分数小于或等于20%的患者中有27%死亡，而射血分数大于或等于30%的患者中这一比例为7%。动态心电图监测的室性心动过速频率与总死亡率（p = 0.008）和猝死（p = 0.003）均独立相关。室性心动过速频率大于0.088次/小时的患者死亡率为34%，而无室性心动过速的患者死亡率为12%。在多变量模型中，功能分级（p = 0.02）和非缺血性心脏病病因（p = 0.04）仍是死亡率的独立预测因素，而跑步机运动持续时间则不是。（摘要截短于250字）
