Boucher C A, Fallon J T, Johnson R A, Yurchak P M
Br Heart J. 1979 May;41(5):613-20. doi: 10.1136/hrt.41.5.613.
Each day, for one year, the medical records of adult patients who died in hospital were reviewed before seeing the necropsy findings. For those patients who had had chronic left or left and right heart failure, a presumptive cause was assigned on the basis of antemortem clinical data. Of 740 consecutive patients who were studied at necropsy, 90 had had chronic heart failure. In 15 patients the cause of heart failure was not apparent by clinical criteria; of these, 7 were found at necropsy to have cardiomyopathic syndrome caused by coronary artery disease. In retrospect, the presence of overt diabetes mellitus was a clue that cardiomyopathy caused by coronary artery disease was the cause of clinically unexplained heart failure; 5 of 7 patients with unexplained heart failure who were found to have this at necropsy were diabetic, whereas only 1 of the other 8 patients with clinically unexplained heart failure was diabetic (P less than 0.05). Patients in whom clinically unexplained heart failure was found to be the result of cardiomyopathy caused by coronary artery disease had multiple myocardial infarctions on pathological examination, which, with one exception, were nontransmural. By contrast, myocardial infarctions were transmural on pathological examination in each of 7 matched 'controls' with heart failure, in whom the diagnosis of coronary artery disease had been clinically apparent (P less than 0.01).
在为期一年的时间里，每天都会在查看尸检结果之前对成年住院死亡患者的病历进行审查。对于那些患有慢性左心或左右心衰竭的患者，根据生前临床数据确定推定病因。在接受尸检研究的740例连续患者中，有90例患有慢性心力衰竭。根据临床标准，15例患者的心力衰竭病因不明显；其中7例在尸检时发现患有冠状动脉疾病引起的心肌病综合征。回顾发现，明显的糖尿病是冠状动脉疾病引起的心肌病是临床无法解释的心力衰竭病因的一个线索；尸检时发现患有这种疾病的7例原因不明的心力衰竭患者中有5例患有糖尿病，而其他8例临床原因不明的心力衰竭患者中只有1例患有糖尿病（P<0.05）。临床原因不明的心力衰竭被发现是由冠状动脉疾病引起的心肌病的患者，病理检查发现有多处心肌梗死，除1例例外，均为非透壁性。相比之下，7例临床诊断为冠状动脉疾病的匹配心力衰竭“对照”患者，病理检查心肌梗死均为透壁性（P<0.01）。
