Nyolczas N, Dékány M, Reif E, Vándor L, Fiók J, Préda I
Haynal Imre Egészségtudományi Egyetem, II. Belgyógyászati Klinika, Budapest.
Orv Hetil. 1995 Aug 13;136(33):1763-8.
Authors assessed the prognostic value of some simple, routinely used non-invasive parameters in dilated cardiomyopathy. Fifty patients, 43 male and 7 female, mean NYHA class 2.3, treated with digitalis, diuretics and vasodilators, were tested. Mean follow up time was 24 months. The evaluated parameters were as follows: maximal exercise capacity, heart rate, systolic blood pressure, as well as rate-pressure product at peak exercise, their increase during the test, fractional shortening measured by M-mode echocardiography, mean pulmonary capillary wedge pressure estimated by apexcardiography and clinical grade of heart failure (NYHA class). Exercise test was multistage, symptom limited, maximal upright bicycle ergometer test. Both one-way and multivariate analysis showed that except of fractional shortening all of the evaluated parameters related significantly to the survival. According to the one-way analysis maximal exercise capacity, rate-pressure product and systolic blood pressure at peak exercise as well as the estimated value of mean pulmonary capillary wedge pressure proved to be the strongest prognosticators. Multivariate analysis showed that the prognostic value of the rate-pressure product at peak exercise and that of the estimated mean pulmonary capillary wedge pressure proved to be additive, their combined consideration resulted in the highest accuracy of prediction.
作者评估了一些简单的、常规使用的非侵入性参数在扩张型心肌病中的预后价值。对50例患者进行了测试,其中男性43例,女性7例,平均纽约心脏协会(NYHA)心功能分级为2.3级,接受洋地黄、利尿剂和血管扩张剂治疗。平均随访时间为24个月。评估的参数如下:最大运动能力、心率、收缩压以及运动峰值时的心率-血压乘积、测试期间它们的增加幅度、通过M型超声心动图测量的缩短分数、通过心尖心动图估计的平均肺毛细血管楔压以及心力衰竭的临床分级(NYHA分级)。运动试验为多级、症状限制的最大直立自行车测力计试验。单因素和多因素分析均显示,除缩短分数外,所有评估参数均与生存率显著相关。根据单因素分析,最大运动能力、运动峰值时的心率-血压乘积和收缩压以及平均肺毛细血管楔压的估计值被证明是最强的预后指标。多因素分析表明,运动峰值时的心率-血压乘积和估计的平均肺毛细血管楔压的预后价值是相加的,综合考虑它们可导致最高的预测准确性。