Liao Y, Cooper R S, McGee D L, Mensah G A, Ghali J K
Department of Preventive Medicine and Epidemiology, Loyola University Medical Center, Maywood, Ill 60153, USA.
JAMA. 1995;273(20):1592-7.
To evaluate the effect of echocardiographically determined left ventricular hypertrophy (LVH) on survival in comparison with number of stenosed vessels and left ventricular systolic dysfunction.
Cohort study based on a consecutive sample from a hospital registry, with a mean follow-up of 5 years.
An inner-city public hospital in Chicago, Ill.
The study included 1089 consecutive black patients who underwent both coronary angiography and M-mode echocardiography as part of a diagnostic evaluation.
Nonstenosed coronary arteries, single-vessel disease, and multivessel disease were found in 48%, 16%, and 36% of patients, respectively; LVH (left ventricular mass index > 131 g/m2 in men and > 100 g/m2 in women) was detected in 50% of patients. Hypertrophy without coexistent obstructive coronary disease was associated with a lower survival rate than that observed for single-vessel disease and was similar to multivessel disease. When LVH, number of diseases vessels, and left ventricular dysfunction were subjected to multivariate analysis, hypertrophy conferred a relative risk (RR) of 2.4 (95% confidence interval [CI], 1.7 to 3.2). By comparison, the presence of a single stenosed vessel did not increase the risk of death. Multivessel disease and ejection fraction less than 45% were associated with an RR of 1.6 (95% CI, 1.1 to 2.2) and 2.0 (95% CI, 1.4 to 2.7), respectively. Calculation of the attributable risk fraction demonstrated that for every 100 deaths in this cohort, LVH independently accounted for 37. The corresponding attributable risk fractions were 1%, 22%, and 9% for single-vessel disease, multivessel disease, and ventricular dysfunction, respectively.
Left ventricular hypertrophy was associated with a greater RR and attributable risk than the traditional measures of coronary disease severity. The high prevalence and powerful risk of LVH make an important contribution to the adverse survival rates among black patients with heart disease and may account for much of the black-white differential.
与狭窄血管数量及左心室收缩功能障碍相比，评估超声心动图测定的左心室肥厚（LVH）对生存率的影响。
基于医院登记处连续样本的队列研究，平均随访5年。
伊利诺伊州芝加哥市的一家市中心公立医院。
该研究纳入了1089例连续的黑人患者，他们作为诊断评估的一部分接受了冠状动脉造影和M型超声心动图检查。
分别在48%、16%和36%的患者中发现非狭窄冠状动脉、单支血管病变和多支血管病变；50%的患者检测到LVH（男性左心室质量指数>131 g/m²，女性>100 g/m²）。无并存阻塞性冠状动脉疾病的肥厚与单支血管病变相比生存率较低，与多支血管病变相似。当对LVH、病变血管数量和左心室功能障碍进行多变量分析时，肥厚的相对风险（RR）为2.4（95%置信区间[CI]，1.7至3.2）。相比之下，存在单支狭窄血管并未增加死亡风险。多支血管病变和射血分数低于45%的相对风险分别为1.6（95%CI，1.1至2.2）和2.0（95%CI，1.4至2.7）。归因风险分数计算表明，在该队列中每100例死亡中，LVH独立占37例。单支血管病变、多支血管病变和心室功能障碍的相应归因风险分数分别为1%、22%和9%。
与传统的冠状动脉疾病严重程度测量指标相比，左心室肥厚与更高的RR和归因风险相关。LVH的高患病率和强大风险对黑人心脏病患者的不良生存率有重要影响，可能是黑人和白人差异的主要原因。
