Nicod P, Gilpin E, Dittrich H, Chappuis F, Ahnve S, Engler R, Henning H, Ross J
Cardiology Division, UCSD Medical Center 92103-1990.
Am J Cardiol. 1988 Jun 1;61(15):1165-71. doi: 10.1016/0002-9149(88)91148-4.
The left ventricular (LV) ejection fraction (EF) is known to be an independent predictor of late prognosis after acute myocardial infarction. Despite a previous report that early heart failure (evidenced only by advanced pulmonary rales in the hospital) can predict prognosis in the absence of severe depression of the LVEF at hospital discharge, the potentially strong influence of various measures of in-hospital heart failure on the predictive ability of LVEF has not been generally appreciated. Accordingly, in 972 patients with acute myocardial infarction the effect on late mortality of the presence or absence in-hospital of both clinical and radiographic signs of LV failure in subgroups of patients with normal, moderately or severely depressed LVEF was examined and measured close to hospital discharge. Patients were divided into 3 groups according to LVEF: group I LVEF less than or equal to 40, n = 265; group II LVEF 0.41 to 0.50, n = 241 and group III LVEF greater than or equal to 0.51, n = 466. When clinical signs of LV failure were present at any time during the coronary care unit period, the 1-year mortality rate after hospital discharge in groups I, II and III was 26, 19 and 8%, compared with 12% (p less than 0.01), 6% (p less than 0.01) and 3% (p less than 0.02), respectively, when signs of LV failure were absent.(ABSTRACT TRUNCATED AT 250 WORDS)
左心室射血分数（EF）是急性心肌梗死后晚期预后的独立预测指标。尽管之前有报告称，早期心力衰竭（仅以住院时出现的晚期肺部啰音为证据）在出院时左心室射血分数无严重降低的情况下可预测预后，但住院期间心力衰竭的各种指标对左心室射血分数预测能力的潜在强大影响尚未得到普遍认识。因此，在972例急性心肌梗死患者中，研究了左心室射血分数正常、中度或重度降低的亚组患者住院时有无左心室衰竭的临床和影像学征象对晚期死亡率的影响，并在接近出院时进行了测量。根据左心室射血分数将患者分为3组：I组左心室射血分数小于或等于40，n = 265；II组左心室射血分数0.41至0.50，n = 241；III组左心室射血分数大于或等于0.51，n = 466。在冠心病监护病房期间的任何时间出现左心室衰竭的临床征象时，I、II和III组出院后1年死亡率分别为26%、19%和8%，而无左心室衰竭征象时分别为12%（p < 0.01）、6%（p < 0.01）和3%（p < 0.02）。（摘要截短于250字）
