Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease.
Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease.
复制标题
心肌灌注不足的程度和严重程度作为疑似冠状动脉疾病患者预后的预测因子。
DOI：
10.1016/s0735-1097(86)80454-5
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发表时间：
1986
影响因子：
24
通讯作者：
Diamond,GA
中科院分区：
文献类型：
--
作者：
Ladenheim,ML;Pollock,BH;Rozanski,A;Berman,DS;Staniloff,HM;Forrester,JS;Diamond,GA
在1,689例有冠状动脉疾病症状但没有心肌梗死或冠状动脉搭桥手术的患者中，评估了运动引起的心肌灌注不足对冠状动脉事件的预测能力。在测试后的一年中，共有74名患者发生冠状动脉事件（12例心脏死亡，20例非致命性梗死，42例在测试后超过60天转诊进行搭桥手术）。逐步逻辑回归只确定了三个独立的预测因素：可逆性灌注不足的心肌区域数量（灌注不足程度的指标），最大灌注不足的程度（灌注不足严重程度的指标）和达到的心率（运动表现的指标）。程度和严重程度均与事件发生率呈指数相关（r = 0.97, p < 0.01），而达到心率与事件发生率呈线性相关（r = 0.79, p < 0.05）。在这些数据的基础上，定义了一个预后模型，该模型采用程度和严重程度作为应力相关的正交变量。使用该模型，预测的冠状动脉事件发生率的范围超过两个数量级——从能够充分运动而没有发生灌注不足的患者的低0.4%，到在低心率（<其最大预测心率的85%）下发生严重和广泛灌注不足的患者的高78%。因此，心肌灌注不足的程度和严重程度是影响疑似冠心病患者预后的重要自变量。
The ability of exercise-induced myocardial hypoperfusion on thallium scintigraphy to predict coronary events was assessed in 1,689 patients with symptoms suggestive of coronary artery disease but without prior myocardial infarction or coronary artery bypass surgery. A total of 74 patients had a coronary event in the year after testing (12 cardiac deaths, 20 nonfatal infarctions and 42 referrals for bypass surgery more than 60 days after testing). Stepwise logistic regression identified only three independent predictors: the number of myocardial regions with reversible hypoperfusion (an index of the extent of hypoperfusion), the maximal magnitude of hypoperfusion (an index of the severity of hypoperfusion) and the achieved heart rate (an index of exercise performance). Both extent and severity were exponentially correlated with event rate (r > 0.97 and p < 0.01 for each), whereas achieved heart rate was linearly correlated with event rate (r = 0.79 and p < 0,05).On the basis of these data, a prognostic model was defined that employs extent and severity as stress-dependent orthogonal variables. Using this model, the predicted coronary event rate ranged over two orders of magnitude—from a low of 0.4% in patients able to exercise adequately without developing hypoperfusion, to a high of 78% in patients developing severe and extensive hypoperfusion at a low heart rate (<85% of their maximal predicted heart rate). Extent and severity of myocardial hypoperfusion, therefore, are important independent variables of prognosis in patients with suspected coronary artery disease.