在有症状和无症状的左心室功能不全患者中，多普勒衍生的早期充盈二尖瓣减速时间的独立和增量预后价值。

Independent and incremental prognostic value of Doppler-derived mitral deceleration time of early filling in both symptomatic and asymptomatic patients with left ventricular dysfunction.

作者信息

Giannuzzi P, Temporelli P L, Bosimini E, Silva P, Imparato A, Corrà U, Galli M, Giordano A

机构信息

Salvatore Maugeri Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Division of Cardiology, Medical Center of Rehabilitation, Veruno (NO), Italy.

出版信息

J Am Coll Cardiol. 1996 Aug;28(2):383-90. doi: 10.1016/0735-1097(96)00163-5.

DOI:10.1016/0735-1097(96)00163-5

PMID:8800114

Abstract

OBJECTIVES

This study sought to investigate the relative and incremental prognostic value of demographic, historical, clinical, echocardiographic and mitral Doppler variables in patients with left ventricular systolic dysfunction.

BACKGROUND

The prognostic value of diastolic abnormalities as assessed by mitral Doppler echocardiography has yet to be defined.

METHOD

A total of 508 patients with left ventricular ejection fraction < or = 35% were followed up for a mean (+/- SD) period of 29 +/- 11 months.

RESULTS

During the follow-up period, 148 patients (29.1%) were admitted to the hospital for congestive heart failure, and 100 patients (19.7%) died. By Cox model analysis, Doppler-derived mitral deceleration time of early filling < or = 125 ms (relative risk [RR] 1.93, 95% confidence interval [CI] 1.4 to 3.7), New York Heart Association functional class III or IV (RR 1.49, 95% CI 1.4 to 2.3), ejection fraction < or = 25% (RR 1.85, 95% CI 1.6 to 2.9), third heart sound (RR 2.06, 95% CI 1.8 to 3.2), age > 60 years (RR 1.95, 95% CI 1.8 to 3.1) and left atrial area > 18 cm2 (RR 1.73, 95% CI 1.6 to 2.7) were all found to be independent and additional predictors of all-cause mortality, and deceleration time was the single best predictor (chi-square 37.80). When all these significant variables were analyzed in hierarchic order, after age, functional class, third sound, ejection fraction and left atrial area, deceleration time still added significant prognostic information (global chi-square from 9.2 to 104.7). Also, deceleration time was the strongest independent predictor of hospital admission for congestive heart failure (RR 4.88, 95% CI 3.7 to 6.9) and cumulative events (congestive heart failure or all-cause mortality, or both; RR 2.44, 95% CI 2.0 to 3.8) in both symptomatic and asymptomatic patients.

CONCLUSIONS

Deceleration time of early filling is a powerful independent predictor of poor prognosis in patients with left ventricular systolic dysfunction, whether symptomatic or asymptomatic. A short (< or = 125 ms) deceleration time by mitral Doppler echocardiography adds important prognostic information compared with other clinical, functional and echocardiographic variables.

摘要

目的

本研究旨在探讨人口统计学、病史、临床、超声心动图及二尖瓣多普勒变量对左心室收缩功能障碍患者的相对及增量预后价值。

背景

经二尖瓣多普勒超声心动图评估的舒张功能异常的预后价值尚未明确。

方法

共纳入508例左心室射血分数≤35%的患者，平均（±标准差）随访29±11个月。

结果

随访期间，148例患者（29.1%）因充血性心力衰竭入院，100例患者（19.7%）死亡。通过Cox模型分析，早期充盈二尖瓣减速时间≤125毫秒（相对风险[RR]1.93，95%置信区间[CI]1.4至3.7）、纽约心脏协会功能分级III或IV级（RR 1.49，95% CI 1.4至2.3）、射血分数≤25%（RR 1.85，95% CI 1.6至2.9）、第三心音（RR 2.06，95% CI 1.8至3.2）、年龄>60岁（RR 1.95，95% CI 1.8至3.1）及左心房面积>18平方厘米（RR 1.73，95% CI 1.6至2.7）均被发现是全因死亡率的独立及额外预测因素，且减速时间是最佳单一预测因素（卡方值37.80）。当按分层顺序分析所有这些显著变量时，在年龄、功能分级、第三心音、射血分数及左心房面积之后，减速时间仍增加了显著的预后信息（全局卡方值从9.2至104.7）。此外，减速时间是充血性心力衰竭住院（RR 4.88，95% CI 3.7至6.9）及累积事件（充血性心力衰竭或全因死亡率，或两者皆有；RR 2.44，95% CI 2.0至3.8）的最强独立预测因素，无论患者有无症状。