Prognostic value of submaximal exercise radionuclide ventriculography after myocardial infarction.
Prognostic value of submaximal exercise radionuclide ventriculography after myocardial infarction.
复制标题
心肌梗死后次最大运动放射性核素心室造影的预后价值。
DOI：
10.1016/0002-9149(83)90181-9
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发表时间：
1983
期刊：
影响因子：
--
通讯作者：
Willerson,JT
中科院分区：
文献类型：
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作者：
Corbett,JR;Nicod,P;Lewis,SE;Rude,RE;Willerson,JT
对117例急性心肌梗死（MI）后17±7天（±标准差）出院前进行放射性核素脑室造影（RVG）亚极限运动试验。在这些研究中验证的假设是，与RVG相结合的亚最大运动测试允许识别在随后的6个月内有未来缺血性事件风险的患者，无论心肌梗死的位置和类型如何。心肌梗死部位33例为前跨壁，39例为下跨壁，18例为有限非跨壁，24例为广泛非跨壁，3例为不确定。随访6个月，9例死亡，14例复发性心绞痛，18例难治性心绞痛，16例限制性心绞痛，17例充血性心力衰竭。判别函数分析将运动对左室射血分数和收缩末期容积的影响列为预测未来心脏事件的所有临床、运动和科学变量中最重要的。在整个组中，左室射血分数和收缩末期容积变化的预测准确性分别为93%和91%，明显比任何程度的st段下降或升高更敏感（p < 0.001）。这些发现通常与心肌梗死的位置和类型无关。因此，心肌梗死后的亚最大运动RVG是识别出院后6个月内存在主要心脏事件风险的患者的准确手段。
Submaximal exercise testing with radionuclide ventriculography (RVG) was performed in 117 patients before hospital discharge 17 ± 7 days (± standard deviation) after an acute myocardial infarction (MI). The hypothesis tested in these studies was that submaximal exercise testing coupled to RVG allows the identification of patients at risk for future ischemic events in the subsequent 6 months, irrespective of MI location and type. The sites of MI were characterized as anterior transmural in 33, inferior transmural in 39, limited nontransmural in 18, extensive nontransmural in 24 and indeterminant in 3. During 6 months of follow-up, 9 patients died, 14 had recurrent MI, 18 had refractory angina pectoris, 16 had limiting angina and 17 had congestive heart failure.Discriminant function analysis ranked exercise changes in left ventricular (LV) ejection fraction and end-systolic volume the most important of all clinical, exercise and scintigraphic variables for predicting future cardiac events. The predictive accuracy of changes in LV ejection fraction and end-systolic volume were 93 and 91%, respectively, for the entire group, and were significantly more sensitive than any degree of ST-segment depression or elevation (p < 0.001). These findings were generally independent of MI location and type. Thus, submaximal exercise RVG after MI is an accurate means of identifying patients at risk for major cardiac events in the 6 months after hospital discharge.