Schulze R A, Strauss H W, Pitt B
Am J Med. 1977 Feb;62(2):192-9. doi: 10.1016/0002-9343(77)90314-x.
Both depressed left ventricular ejection fraction and ventricular arrhythmias have been associated with a poor prognosis following acute myocardial infarction. To assess the relative role of each of these parameters in predicting mortality in the early period after hospitalization for myocardial infarction, 24 hour ambulatory electrocardiographic tape recordings and gated cardiac blood pool scans were obtained in 81 patients approximately two weeks after their admission to the hospital for myocardial infarction. Lown class 0 to II ventricular premature contractions during this period were classified as uncomplicated ventricular arrhythmias and Lown class III to V ventricular premature contractions were classified as complicated ventricular arrhythmias. Ejection fraction was calculated from biplane images of gated cardiac blood pool scans. In 35 patients the ejection fraction was greater than or equal to 0.40; only three of these had complicated ventricular arrhythmias. In 45 patients the ejection fraction was less than 0.40; 26 of these had complicated ventricular arrhythmias. Eight patients had documented ventricular fibrillation or instantaneous death during a mean 7.0 moonth (range 2 to 16 months) follow-up period outside the hospital. Although the number of patients studied was small, and there were only eight sudden deaths, life table analysis projected a one year mortality of 66 per cent in patients with complicated ventricular arrhythmias and 31 per cent in patients with an ejection fraction less than 0.40. All eight patients who died suddenly were in the subgroup of 26 patients with an ejection fraction less than 0.40 and complicated ventricular arrhymias; none was in the subgroup of 19 patients with an ejection fraction less than 0.40 and uncomplicated ventricular arrhythmias (P less than 0.02). Although a low ejection fraction may suggest a poor prognosis following myocardial infarction, the presence of complicated ventricular arrhythmias significantly increases the risk of sudden cardiac death in the early period after hospitalization in patients with low ejection fraction.
左心室射血分数降低和室性心律失常均与急性心肌梗死后的不良预后相关。为了评估这些参数各自在预测心肌梗死住院后早期死亡率中的相对作用，在81例心肌梗死入院约两周的患者中进行了24小时动态心电图磁带记录和门控心血池扫描。在此期间，洛恩分级0至II级室性早搏被分类为无并发症的室性心律失常，洛恩分级III至V级室性早搏被分类为有并发症的室性心律失常。射血分数由门控心血池扫描的双平面图像计算得出。35例患者的射血分数大于或等于0.40；其中只有3例有并发症的室性心律失常。45例患者的射血分数小于0.40；其中26例有并发症的室性心律失常。8例患者在院外平均7.0个月（范围2至16个月）的随访期内记录到心室颤动或猝死。尽管研究的患者数量较少，且仅有8例猝死，但生命表分析预测，有并发症的室性心律失常患者的一年死亡率为66%，射血分数小于0.40的患者为31%。所有8例猝死患者均在射血分数小于0.40且有并发症的室性心律失常的26例患者亚组中；射血分数小于0.40且无并发症的室性心律失常的19例患者亚组中无一人死亡（P小于0.02）。尽管低射血分数可能提示心肌梗死后预后不良，但有并发症的室性心律失常的存在显著增加了射血分数低的患者住院后早期心源性猝死的风险。
