Mulcahy D, Gunning M, Knight C, Patel D, Davies M, Underwood R, Sutton G, Clarke D, Wright C, Saia F, Fox K
Royal Brompton and Harefield NHS Trust, London, UK.
Eur Heart J. 1998 Sep;19(9):1342-7. doi: 10.1053/euhj.1998.1013.
(a) to assess short (1 year) and long-term (5 year) changes in left ventricular ejection fraction in patients with stable coronary disease with or without ECG evidence of transient ischaemia during daily life on routine therapy, and (b) to assess whether patients with recurrent transient ischaemic episodes have a particular propensity to gradual deterioration in left ventricular ejection fraction in the absence of infarction.
One hundred and forty eight patients (127 males; mean age 59 years), part of a natural history cohort of 172 patients who had undergone exercise testing, 48 h ambulatory ST monitoring, and resting radionuclide ventriculography at baseline, and who had not suffered any intervening cardiac event, underwent repeat radionuclide ventriculography at 1 year follow-up on identical or very similar medications. Furthermore, 56 patients (50 males; mean age 65 years) of this cohort, who had ischaemia both on exercise testing and ambulatory monitoring at baseline (n=33), or no ischaemia on either test at baseline (n=23), and who had suffered no intervening event, underwent repeat exercise testing, ambulatory monitoring and radionuclide ventriculography at a mean of 61.8 months follow-up. In 38 of these 56 cases, long-term testing mirrored baseline testing in terms of presence or absence of ischaemia (both tests +, n=25; both tests -, n=13). At one year there was no change in left ventricular ejection fraction, either for the whole group (n=148; left ventricular ejection fraction 47=11.6% - 47.13+11.07%, P=ns) or for subgroups with (n=62; left ventricular ejection fraction 48+12.1%-48.5+10.5%, P=ns) and without (n=86; left ventricular ejection fraction 46.2+10.4%-46.2+11.3%, P=ns) evidence of transient ischaemia at baseline. At 61 months, there was a small fall in mean left ventricular ejection fraction for the total study group (n=56; left ventricular ejection fraction 45.8+9.3%-42.1+8.8%, P<0.05); however, this fall was not significant for those patients with both baseline and 5 year evidence of transient ischaemia (n=25; left ventricular ejection fraction 44.9+8.7%-41.3+7.5%, P=0.056).
In medically treated stable coronary patients who do not suffer any intervening cardiac event, recurrent transient (silent) ischaemic episodes do not, in themselves, lead to gradual deterioration in left ventricular systolic function over a 1-5 year period.
（a）评估接受常规治疗的稳定性冠心病患者，无论日常生活中有无心电图证实的短暂性缺血证据，其左心室射血分数的短期（1年）和长期（5年）变化；（b）评估反复发生短暂性缺血发作的患者在无梗死情况下左心室射血分数是否有逐渐恶化的特殊倾向。
148例患者（127例男性；平均年龄59岁），他们是172例自然病史队列研究中的一部分，这些患者在基线时接受了运动试验、48小时动态ST段监测和静息放射性核素心室造影，且未发生任何介入性心脏事件，在1年随访时在相同或非常相似的药物治疗下接受了重复放射性核素心室造影。此外，该队列中的56例患者（50例男性；平均年龄65岁），他们在基线时运动试验和动态监测均有缺血（n = 33），或两项检查均无缺血（n = 23），且未发生介入性事件，在平均61.8个月的随访时接受了重复运动试验、动态监测和放射性核素心室造影。在这56例患者中的38例，长期检查在有无缺血方面与基线检查一致（两项检查均阳性，n = 25；两项检查均阴性，n = 13）。1年时，整个组（n = 148；左心室射血分数47 = 11.6% - 47.13 + 11.07%，P = 无显著性差异）、基线时有短暂性缺血证据的亚组（n = 62；左心室射血分数48 + 12.1% - 48.5 + 10.5%，P = 无显著性差异）和无短暂性缺血证据的亚组（n = 86；左心室射血分数46.2 + 10.4% - 46.2 + 11.3%，P = 无显著性差异）的左心室射血分数均无变化。61个月时，整个研究组（n = 56；左心室射血分数45.8 + 9.3% - 42.1 + 8.8%，P < 0.05）的平均左心室射血分数有小幅下降；然而，对于基线和5年时均有短暂性缺血证据的患者（n = 25；左心室射血分数44.9 + 8.7% - 41.3 + 7.5%，P = 0.056），这种下降并不显著。
在接受药物治疗的稳定性冠心病患者中，若未发生任何介入性心脏事件，反复发生的短暂性（无症状）缺血发作本身并不会在1至5年期间导致左心室收缩功能逐渐恶化。
