Iida Yuichiro, Inomata Takayuki, Kaida Toyoji, Fujita Teppei, Ikeda Yuki, Nabeta Takeru, Ishii Shunsuke, Koitabashi Toshimi, Takeuchi Ichiro, Ako Junya
Department of Cardiovascular Medicine, Kitasato University School of Medicine.
Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital.
Int Heart J. 2017 Aug 3;58(4):544-550. doi: 10.1536/ihj.16-582. Epub 2017 Jul 13.
The clinical impact of left ventricular (LV) segmental wall motion abnormalities (SWMA) in patients with idiopathic dilated cardiomyopathy (IDCM) has not been well elucidated.Among 100 consecutive IDCM patients with follow-up visits, we enrolled 85 after excluding those with left bundle branch block and/or ventricular pacemaker implantation. LV wall motion was assessed using left ventriculography scored for 7 segments according to the American Heart Association classification as follows: 0, normokinesis; 1, hypokinesis; 2, akinesis; and 3, dyskinesis. SWMA were defined as a score dispersion of more than 1 degree among the segments.SWMA was exhibited by 26 patients. Kaplan-Meier curves demonstrated that the patients with SWMA (SWMA+) had a significantly higher cardiac event-free rate than the patients without SWMA (P < 0.001). Cox proportional hazards analysis showed that SWMA+ was an independent predictor of cardiac events (P = 0.03; hazard ratio = 3.38; 95% confidence interval [CI], 1.11-10.8). Furthermore, multiple regression analysis showed that SWMA+ was an independent predictor of decreased LV end-systolic dimension index after optimal pharmacotherapy (β = -0.24; 95%CI, -9.12 to -0.73; P = 0.02).SWMA is common in patients with IDCM and is independently associated with a poor prognosis and less morphometric and functional improvement of LV in response to pharmacotherapy.
特发性扩张型心肌病（IDCM）患者左心室（LV）节段性室壁运动异常（SWMA）的临床影响尚未得到充分阐明。在100例连续随访的IDCM患者中，我们排除了左束支传导阻滞和/或植入心室起搏器的患者后，纳入了85例患者。根据美国心脏协会的分类，使用左心室造影对LV壁运动进行7个节段评分：0，运动正常；1，运动减弱；2，运动消失；3，运动障碍。SWMA定义为各节段评分离散度超过1度。26例患者出现SWMA。Kaplan-Meier曲线显示，有SWMA的患者（SWMA+）无心脏事件发生率显著高于无SWMA的患者（P < 0.001）。Cox比例风险分析表明，SWMA+是心脏事件的独立预测因素（P = 0.03；风险比 = 3.38；95%置信区间[CI]，1.11 - 10.8）。此外，多元回归分析显示，SWMA+是最佳药物治疗后LV收缩末期内径指数降低的独立预测因素（β = -0.24；95%CI，-9.12至-0.73；P = 0.02）。SWMA在IDCM患者中很常见，并且独立地与不良预后以及药物治疗后LV形态和功能改善较少相关。
