The influence of left ventricular hypertrophy on survival in patients with coronary artery disease: Do race and gender matter?
The influence of left ventricular hypertrophy on survival in patients with coronary artery disease: Do race and gender matter?
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DOI：
10.1016/s0735-1097(02)03006-1
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发表时间：
2003-03-19
影响因子：
24
通讯作者：
Peterson, ED
中科院分区：
文献类型：
--
作者：
East, MA;Jollis, JG;Peterson, ED
我们试图确定左心室肥大（LVH）在冠状动脉疾病（CAD）患者中的总体预后重要性，以及确定这种风险是否随种族或性别而变化。黑人和妇女也有较高的死亡率与coronarydisease.METHODS我们研究了2,461例患者（19%黑人，42%妇女）在1990年和1998年之间从一个单一的学术中心心导管诊断为CAD的记录。采用标准超声心动图测量定义左心室肥大。采用考克斯比例风险模型进行校正生存分析。结果LVH患者年龄较大（68岁对65岁，p < 0.01），女性（54%对36%，p < 0.01）和黑人（25%对16%，p <0.01）更常见，与无LVH患者相比，未校正的3年死亡率更高（42%对34%，p < 0.01）。校正其他临床危险因素后，左心室肥厚仍然是死亡率的独立预测因子（风险比1.56，95%置信区间1.35 - 1.80），其预后重要性与左心室射血分数相当。虽然LVH的相对危险度并不因种族或性别而异，但LVH的归因危险度在黑人和women.CONCLUSIONS中更大，临床医生在评估CAD患者的风险时应考虑LVH的预后重要性。由于LVH在黑人和女性CAD患者中更常见，这部分解释了生存率的种族和性别差异。(C)2003年由美国心脏病学会基金会。
OBJECTIVES We sought to determine the overall prognostic importance of left ventricular hypertrophy (LVH) among patients with coronary artery disease (CAD), as well as to determine whether this risk varies as a function of race or gender.BACKGROUND Left ventricular hypertrophy is more prevalent among blacks and women than their counterparts. Blacks and women also have higher mortality with coronary disease.METHODS We studied records of 2,461 patients (19% black, 42% women) diagnosed with CAD at cardiac catheterization between 1990 and 1998 from a single academic center. Left ventricular hypertrophy was defined using standard echocardiographic measures. Cox proportional hazards models were used for adjusted survival analyses. Mean patient follow-up was three years.RESULTS Patients with LVH were older (68 vs. 65 years, p < 0.01), more often women (54% vs. 36%, p < 0.01), and black (25% vs. 16%, p < 0.01), and had higher unadjusted three-year mortality rates than patients without LVH (42% vs. 34%, p < 0.01). Left ventricular hypertrophy remained an independent predictor of mortality after adjusting for other clinical risk factors (hazard ratio 1.56, 95% confidence interval 1.35 to 1.80) with prognostic importance equivalent to that of left ventricular ejection fraction. Although the relative risk of LVH did not vary by race or gender, the attributable risk of LVH was greater in blacks and women.CONCLUSIONS Clinicians should consider the prognostic importance of LVH when assessing risk in patients with CAD. Because LVH is more common among black-and women patients with CAD, it partially accounts for racial and gender differences in survival. (C) 2003 by the American College of Cardiology Foundation.