Usefulness of two-dimensional echocardiography during low-level exercise testing early after uncomplicated acute myocardial infarction.
Usefulness of two-dimensional echocardiography during low-level exercise testing early after uncomplicated acute myocardial infarction.
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二维超声心动图在无并发症的急性心肌梗死后早期低水平运动测试中的作用。
DOI：
10.1016/0002-9149(87)90974-x
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发表时间：
1987
期刊：
影响因子：
--
通讯作者：
Crawford,MH
中科院分区：
文献类型：
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作者：
Applegate,RJ;Dell'Italia,LJ;Crawford,MH
为了确定在低水平、限制性踏车运动恢复后立即进行的节段性和整体性左心室（LV）功能的二维（2-D）超声心动图测量是否与峰值自行车运动时测量的相同变量一样敏感，对21例急性心肌梗死（AMI）后患者进行了研究。21例患者中，18例（86%）恢复期踏车射血分数分析可预测峰值自行车结果，17例（81%）恢复期踏车室壁运动异常可预测峰值自行车分析（p < 0.01）。这些数据表明，2-D超声心动图在低水平梗死后活动平板试验的即刻恢复期与节段性和整体LV功能的峰值运动评估一样敏感。因此，在平均11个月（范围3至24）的随访间隔期间，对67例患者的休息和恢复运动指标的预测价值进行了前瞻性评估。67例患者中有16例（24%）发生了新发心脏事件（3例心源性死亡，8例复发性AMI和6例冠状动脉旁路移植术），其临床特征和活动平板心电图结果未确定。然而，在这16例发生事件的患者中有7例（44%）恢复期射血分数单位下降超过10%，而在51例无事件的患者中只有4例（13%）下降超过10%（p < 0.002），16例患者中有10例（63%）在运动恢复时观察到新的或恶化的室壁运动异常，而51例中仅10例（20%）无（P <0.001）。多变量logistic回归分析确定，按显著性顺序，运动恢复时室壁运动异常（p < 0.001）、平板运动时心绞痛（p < 0.04）和静息射血分数（p < 0.04）是未来心脏事件的预测因子。因此，在低水平AMI后平板运动试验的恢复期，2-D超声心动图与节段性和整体LV功能的峰值运动评估一样敏感;运动恢复时射血分数单位降低超过10%或新发或恶化的室壁运动异常可识别出大量心脏事件高风险的无并发症梗死患者。
To determine whether 2-dimensional (2-D) echocardiographic measures of segmental and global left ventricular (LV) function immediately on recovery of low-level, symptom-limited treadmill exercise are as sensitive as the same variables measured at peak bicycle exercise, 21 patients were studied after acute myocardial infarction (AMI). The recovery treadmill ejection fraction analysis was predictive of the peak bicycle results in 18 of the 21 patients (86%) and recovery treadmill wall motion abnormalities were predictive of the peak bicycle analysis in 17 (81%) (p < 0.01). These data indicate that 2-D echocardiography during the immediate recovery phase of low-level post-infarction treadmill testing was as sensitive as the peak exercise assessment of segmental and global LV function. Accordingly, the predictive value of rest and recovery exercise measures were prospectively assessed in 67 patients during a mean follow-up interval of 11 months (range 3 to 24). Clinical characteristics and treadmill electrocardiographic findings did not identify the 16 of 67 patients (24%) who had new cardiac events (3 cardiac deaths, 8 recurrent AMIs and 6 coronary artery bypass graft operations). However, a decrease in recovery ejection fraction units of more than 10% was seen in 7 of these 16 patients (44%) with events, compared with only 4 of the 51 (13%) without events (p < 0.002), and new or worsening wall motion abnormalities on exercise recovery were seen in 10 of the 16 patients (63%) with events, but in only 10 of the 51 (20%) without (p <0.001). A multivariate logistic regression analysis identified, in order of significance, wall motion abnormalities on recovery of exercise (p < 0.001), angina pectoris during treadmill exercise (p < 0.04) and rest ejection fraction (p < 0.04) as predictors of future cardiac events. Thus, 2-D echocardiography during the recovery phase of low-level post-AMI treadmill exercise testing is as sensitive as the peak exercise assessment of segmental and global LV function; and a decrease in ejection fraction units of more than 10 % or new or worsening wall motion abnormalities on recovery of exercise identify a significant number of patients with uncomplicated infarction at high risk for cardiac events.