Traina M, Rotolo A, Raineri M, Trapani R, Candela B, Raineri A A
Cattedra di Cardiologia, Università degli Studi di Palermo, Italy.
Eur Heart J. 1993 Aug;14(8):1034-9. doi: 10.1093/eurheartj/14.8.1034.
Several controlled trials on the thrombolytic treatment of acute myocardial infarction (AMI) have failed to demonstrate that thrombolysis has a simultaneous positive effect on left ventricular function and survival. One explanation may be that spontaneous changes in left ventricular function occurred during the progression of AMI in control patients. The aim of this study was to evaluate the spontaneous evolution of left ventricular ejection fraction (LVEF) and its prognostic influence on early (1 month) and late (1 year) mortality in patients with AMI. We studied 216 patients admitted to our CCU within 24 h of the onset of symptoms. LVEF was determined by radionuclide ventriculography on admission (RNV1) and at the end of the necrotic phase (RNV2). Fourteen patients died before RNV2. On the basis of LVEF values at RNV1, the remaining 202 patients were divided into two groups: those with a normal LVEF (> or = 55%), and those with an abnormal LVEF (< 55%). Among patients with a normal LVEF at RNV1 (64 patients), a significant increase (> 12%) in LVEF at RNV2 was observed in 12.5%, a significant decrease (> 12%) in 12.5% and no change at all in 75%. All of these patients survived, regardless of the evolution of LVEF. In patients with an abnormal LVEF at RNV1 (138) a significant increase (> 5%) in LVEF at RNV2 was observed in 72.5%, a significant decrease (> 5%) in 6.5% and no change at all in 21%.(ABSTRACT TRUNCATED AT 250 WORDS)
几项关于急性心肌梗死（AMI）溶栓治疗的对照试验未能证明溶栓对左心室功能和生存率有同步的积极影响。一种解释可能是，在对照患者的AMI进展过程中，左心室功能发生了自发变化。本研究的目的是评估急性心肌梗死患者左心室射血分数（LVEF）的自发演变及其对早期（1个月）和晚期（1年）死亡率的预后影响。我们研究了216名在症状发作后24小时内入住我们冠心病监护病房的患者。入院时（RNV1）和坏死期结束时（RNV2）通过放射性核素心室造影测定LVEF。14名患者在RNV2之前死亡。根据RNV1时的LVEF值，其余202名患者分为两组：LVEF正常（≥55%）的患者和LVEF异常（<55%）的患者。在RNV1时LVEF正常的患者（64例）中，12.5%的患者在RNV2时LVEF显著增加（>12%），12.5%的患者显著降低（>12%），75%的患者无变化。所有这些患者均存活，无论LVEF的演变情况如何。在RNV1时LVEF异常的患者（138例）中，72.5%的患者在RNV2时LVEF显著增加（>5%），6.5%的患者显著降低（>5%），21%的患者无变化。（摘要截断于250字）
