Køber L, Torp-Pedersen C, Pedersen O D, Høiberg S, Camm A J
Department of Cardiology P, Gentofte University Hospital of Copenhagen, Denmark.
Am J Cardiol. 1996 Nov 15;78(10):1124-8. doi: 10.1016/s0002-9149(96)90064-8.
Left ventricular (LV) systolic function and congestive heart failure (CHF) are important predictors of long-term mortality after acute myocardial infarction. The importance of transient CHF and the interaction of CHF and LV function on prognosis has not been studied in detail previously. In the TRAndolapril Cardiac Evaluation Study, 6,676 consecutive patients with acute myocardial infarction 1 to 6 days earlier had LV systolic function quantified as wall motion index (echocardiography), which is closely correlated to LV ejection fraction. To study the interaction of CHF and wall motion index on long-term mortality, separate analyses were performed in patients with different levels of LV function. Risk ratio (95% confidence intervals [CI]) were determined from proportional hazard models subgrouped by wall motion index or CHF adjusted for age and gender. Heart failure was separated into transient or persistent. Wall motion index and CHF are correlated. Furthermore, there is an interaction between wall motion index and CHF. The prognostic importance of wall motion index depends on whether patients have CHF or not: the risk ratio associated with decreasing 1 wall motion index unit is 3.0 (2.6 to 3.4) in patients with CHF, and 2.2 (1.7 to 2.9) in patients without CHF when adjusted for age and gender. Similarly, the prognostic importance of CHF depends on the level of wall motion index: the risk ratio associated with CHF is 3.9 (1.8 to 8.3) when the wall motion index is <0.8 and 1.9 (1.5 to 2.3) when the wall motion index is >1.6. Transient CHF is an independent risk factor (risk ratio 1.5, confidence interval [CI] 1.3 to 1.8) although milder than persistent CHF (risk ratio 2.8, CI 2.5 to 3.2).
左心室（LV）收缩功能和充血性心力衰竭（CHF）是急性心肌梗死后长期死亡率的重要预测指标。短暂性CHF的重要性以及CHF与LV功能对预后的相互作用此前尚未得到详细研究。在群多普利心脏评估研究中，6676例1至6天前连续发生急性心肌梗死的患者的LV收缩功能被量化为壁运动指数（超声心动图），其与LV射血分数密切相关。为研究CHF与壁运动指数对长期死亡率的相互作用，对不同LV功能水平的患者进行了单独分析。风险比（95%置信区间[CI]）由按壁运动指数或CHF分组并根据年龄和性别调整的比例风险模型确定。心力衰竭分为短暂性或持续性。壁运动指数与CHF相关。此外，壁运动指数与CHF之间存在相互作用。壁运动指数的预后重要性取决于患者是否患有CHF：在调整年龄和性别后，CHF患者中壁运动指数每降低1个单位的风险比为3.0（2.6至3.4），无CHF患者为2.2（1.7至2.9）。同样，CHF的预后重要性取决于壁运动指数水平：壁运动指数<0.8时，与CHF相关的风险比为3.9（1.8至8.3）；壁运动指数>1.6时，风险比为1.9（1.5至2.3））。短暂性CHF是一个独立的危险因素（风险比1.5，置信区间[CI] 1.3至1.8），尽管比持续性CHF（风险比为2.8，CI 2.5至3.2）轻。
