Wang X L, Tam C, McCredie R M, Wilcken D E
Department of Cardiovascular Medicine, University of New South Wales, Prince Henry/Prince of Wales Hospitals, Sydney.
Aust N Z J Med. 1995 Aug;25(4):309-15. doi: 10.1111/j.1445-5994.1995.tb01895.x.
The degree of left ventricular (LV) impairment is an important determinant of long term outcome in patients with coronary artery disease (CAD).
We aimed to determine variables predictive of the severity of LV dysfunction in men and women aged 65 years or less with CAD, and to quantitate their contributions.
We documented atherogenic variables and extent of LV impairment and CAD severity at angiography in 521 consecutively studied men and women aged 65 years or less (381 males and 140 females). We assessed severity from an LV impairment score (Green Lane) and the ejection fraction. We related severity to quantitative and categorical variables which included the severity of angina (no angina, stable and unstable angina).
The LV impairment score correlated closely (negatively) with the ejection fraction (r = -0.783, p = 0.0001). There were eight variables independently predictive of the severity of LV impairment assessed by the LV score. The variables in descending order of relative importance in predicting the LV scores were past history of myocardial infarction (MI), number of significantly diseased vessels (> 50% luminal obstruction), life-time smoking dose, log-triglycerides, total cholesterol to HDL-C ratio, hypertension, age and Body Mass Index (BMI). They were all positive relationships. Together they correctly classified the LV scores of 52.6% of the patients. Gender was not an independent contributor to the LV score when other variables were controlled. When the contributions to the variance in LV scores of past history of MI (15.4%) and number of significantly diseased vessels (2.6%) were controlled, life-time smoking dose independently explained 2.1% (p < 0.01) of the variance. The LV impairment score was 55% higher in heavy smokers than in non-smokers (p = 0.01). When we compared patients with stable and unstable angina, LV scores are higher and ejection fraction lower in the unstable angina patients consistent with them having a greater degree of LV dysfunction.
We conclude that variables other than a history of MI and CAD severity contribute significantly to the variance of the degree in LV impairment in CAD patients among which the life-time smoking dose, triglycerides, TC/HDL-C, hypertension and increased BMI are all relevant to prevention, and that patients with unstable vs stable angina usually have more impaired LV function.
左心室（LV）功能损害程度是冠心病（CAD）患者长期预后的重要决定因素。
我们旨在确定65岁及以下CAD男性和女性患者左心室功能障碍严重程度的预测变量，并对其作用进行量化。
我们记录了521例连续研究的65岁及以下男性和女性（381例男性和140例女性）的动脉粥样硬化变量、左心室损害程度和冠状动脉造影时的CAD严重程度。我们通过左心室损害评分（格林莱恩评分）和射血分数评估严重程度。我们将严重程度与定量和分类变量相关联，这些变量包括心绞痛的严重程度（无心绞痛、稳定型心绞痛和不稳定型心绞痛）。
左心室损害评分与射血分数密切相关（呈负相关）（r = -0.783，p = 0.0001）。有8个变量可独立预测通过左心室评分评估的左心室损害严重程度。在预测左心室评分时，按相对重要性降序排列的变量依次为心肌梗死（MI）病史、严重病变血管数量（管腔阻塞>50%）、终生吸烟量、对数甘油三酯、总胆固醇与高密度脂蛋白胆固醇比值、高血压、年龄和体重指数（BMI）。它们均呈正相关。这些变量共同正确分类了52.6%患者的左心室评分。在控制其他变量时，性别不是左心室评分的独立影响因素。当控制MI病史（15.4%）和严重病变血管数量（2.6%）对左心室评分方差的影响时，终生吸烟量独立解释了2.1%（p < 0.01）的方差。重度吸烟者的左心室损害评分比不吸烟者高55%（p = 0.01）。当我们比较稳定型心绞痛和不稳定型心绞痛患者时，不稳定型心绞痛患者的左心室评分更高，射血分数更低，这与他们左心室功能障碍程度更大一致。
我们得出结论，除MI病史和CAD严重程度外，其他变量对CAD患者左心室损害程度的方差有显著影响，其中终生吸烟量、甘油三酯、总胆固醇/高密度脂蛋白胆固醇比值、高血压和BMI升高均与预防相关，且不稳定型心绞痛患者与稳定型心绞痛患者相比，左心室功能通常受损更严重。
