[右心室收缩功能对心肌梗死后的预后价值]

[The postinfarct prognostic value of right ventricular systolic function].

作者信息

Candell Riera J, Rius Daví A, Castell Conesa J, Aguadé Bruix S, Olona Cabases M, Permanyer Miralda G, Soler Soler J

机构信息

Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona.

出版信息

Rev Esp Cardiol. 1995 Feb;48(2):115-21.

PMID:7886262

Abstract

BACKGROUND

Right ventricular extension of inferior myocardial infarction has been shown to be a predictor of poor prognosis during the acute phase. However, it is not known whether right ventricular dysfunction predicts long term complications. The aim of the present study was to assess whether right ventricular ejection fraction is also a predictor of poor prognosis during the first five follow-up years.

METHODS

Ninety-eight consecutive patients (age < or = 65 years) with acute noncomplicated myocardial infarction (49 anterior and 49 inferior) were evaluated before hospital discharge. In all of them the ejection fraction of both ventricles was evaluated with radionuclide ventriculography at rest and during submaximal exercise. All patients were clinically followed up for at least 5 years. The prognostic relevance of right and left ventricular function for the prediction of all complications and severe complications was assessed using univariate and multivariate analysis.

RESULTS

After 5 years, 66 patients had 94 complications (angina in 44, heart failure in 21, reinfarction in 10, revascularization procedures in 11, death in 6). In the univariate analysis, resting right ventricular ejection fraction was significantly lower in patients with inferior infarction and severe complications at one year (32 +/- 12% vs 38 +/- 6%, p = 0.03). However, in multivariate analysis only resting left ventricular ejection fraction was predictive of complications at 5 years (odds ratio 5.93, 95% confidence interval = 1.32-26.6). Statistical results did not change when the ejection fraction of both ventricles during submaximal exercise was considered.

CONCLUSIONS

Although right ventricular ejection fraction, measured before hospital discharge, is predictive of complications at five years in inferior infarctions, multivariate analysis shows that it does not add prognostic information to the measurement of left ventricular ejection fraction in patients with uncomplicated acute myocardial infarction, either anterior or inferior.

摘要

背景

下壁心肌梗死累及右心室已被证明是急性期预后不良的一个预测指标。然而，右心室功能障碍是否能预测长期并发症尚不清楚。本研究的目的是评估右心室射血分数是否也是随访前五年预后不良的一个预测指标。

方法

对98例连续的急性非复杂性心肌梗死患者（年龄≤65岁）（前壁梗死49例，下壁梗死49例）在出院前进行评估。所有患者均通过放射性核素心室造影在静息和次极量运动时评估双心室射血分数。所有患者均进行了至少5年的临床随访。使用单因素和多因素分析评估右心室和左心室功能对所有并发症和严重并发症预测的预后相关性。

结果

5年后，66例患者出现94种并发症（心绞痛44例，心力衰竭21例，再梗死10例，血管重建术11例，死亡6例）。在单因素分析中，下壁梗死且1年时出现严重并发症的患者静息右心室射血分数显著降低（32±12%对38±6%，p = 0.03）。然而，在多因素分析中，只有静息左心室射血分数可预测5年时的并发症（比值比5.93，95%置信区间 = 1.32 - 26.6）。当考虑次极量运动时双心室射血分数时，统计结果未改变。