Stein J H, Neumann A, Preston L M, Vandenberg B J, Parrillo J E, Calvin J E, Marcus R H
Department of Medicine, Rush Medical College, Chicago, Illinois, USA.
Clin Cardiol. 1998 Oct;21(10):725-30. doi: 10.1002/clc.4960211006.
Current protocols for risk stratification of patients with acute chest pain syndromes rely on clinical parameters and are oriented toward identification of patients at high risk for adverse cardiac events; however, this paradigm for risk stratification does not adequately address the observation that adverse cardiac events are relatively uncommon in this population. In an era of cost containment, consideration also should be given to identification of patients at low risk for adverse cardiac events, who may be safely discharged without expensive inpatient hospitalization.
The purpose of this study was to develop echocardiographic predictors that identify unstable angina patients at low risk for adverse cardiac events and that discriminate between low- and high-risk patients.
The predictive accuracy of retrospectively determined echocardiographic predictors were compared in a population-based sample of 66 consecutive unstable angina patients undergoing echocardiography within 24 h of admission.
Echocardiographic predictors of adverse events included wall motion score index > or = 0.2, ejection fraction < or = 40%, and mitral regurgitation severity > 2. One or more echocardiographic predictors of adverse events were present in 32 patients (48%). A composite echocardiographic predictor of adverse events was specific, had a high positive predictive value for the identification of high-risk patients, and discriminated between unstable angina patients at high and low risk for adverse cardiac events.
Echocardiographic predictors of adverse events are specific and discriminate between unstable angina patients at high and low risk for adverse cardiac events.
目前急性胸痛综合征患者风险分层方案依赖临床参数，旨在识别发生不良心脏事件高风险的患者；然而，这种风险分层模式未充分考虑到该人群中不良心脏事件相对不常见这一情况。在成本控制的时代，还应考虑识别发生不良心脏事件低风险的患者，这些患者可安全出院而无需昂贵的住院治疗。
本研究的目的是开发超声心动图预测指标，以识别发生不良心脏事件低风险的不稳定型心绞痛患者，并区分低风险和高风险患者。
在一个基于人群的样本中，对66例连续的不稳定型心绞痛患者在入院24小时内接受超声心动图检查，比较回顾性确定的超声心动图预测指标的预测准确性。
不良事件的超声心动图预测指标包括室壁运动评分指数≥0.2、射血分数≤40%以及二尖瓣反流严重程度＞2级。32例患者（48%）存在一项或多项不良事件的超声心动图预测指标。不良事件的综合超声心动图预测指标具有特异性，对识别高风险患者具有较高的阳性预测价值，且能区分不稳定型心绞痛患者发生不良心脏事件的高风险和低风险。
不良事件的超声心动图预测指标具有特异性，能区分不稳定型心绞痛患者发生不良心脏事件的高风险和低风险。
