A standardized definition of ischemic cardiomyopathy for use in clinical research
A standardized definition of ischemic cardiomyopathy for use in clinical research
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DOI：
10.1016/s0735-1097(01)01738-7
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发表时间：
2002-01-16
影响因子：
24
通讯作者：
O'Connor, CM
中科院分区：
文献类型：
--
作者：
Felker, GM;Shaw, LK;O'Connor, CM
我们试图评估冠状动脉疾病（CAD）的程度和有症状的心力衰竭（HF）患者的存活率之间的关系，并建立缺血性心肌病的最有说服力的临床定义。但是，在此情况下，缺血性心肌病没有统一的定义。方法我们评估了有症状的HF和射血分数小于或等于40%的患者的临床病史和冠状动脉解剖在1986年至1999年期间接受诊断性冠状动脉造影术（n = 1，921）。五个分类方案进行了测试，以确定最强大的方法来定义CAD的程度，并制定最好的定义缺血性心肌病的预后purpose.RESULTS一个更广泛的CAD是独立相关的生存期较短。当比较各种分类方案时，改良的病变血管数分类，其中单支血管病变且既往无血运重建或心肌梗死（MI）病史的患者被分类为非缺血性，提供了最大的预后能力。缺血性心肌病的定义，包括这个定义有更多的预后比传统的definition.CONCLUSIONS血管造影诊断缺血性HF与较短的生存期比非缺血性HF。更广泛的CAD与更短的生存期独立相关，单支血管病变且无MI或血运重建史的患者应归类为非缺血性，以用于预后目的。缺血性心肌病定义的标准化将有助于HF临床研究的开展和解释。(C)2002年由美国心脏病学会发布。
OBJECTIVES We sought to evaluate the association between the extent of coronary artery disease (CAD) and survival in patients with symptomatic heart failure (HF) and to create the most prognostically powerful clinical definition of ischemic cardiomyopathy.BACKGROUND An ischemic etiology of HF is known to be a predictor of adverse outcome; however, there is no uniform definition for ischemic cardiomyopathy.METHODS We assessed the clinical history and coronary anatomy of patients with symptomatic HF and ejection fraction less than or equal to40% undergoing diagnostic coronary angiography between 1986 and 1999 (n = 1,921). Five classification schemes were tested to identify the most prognostically powerful method for defining the extent of CAD and to develop the best definition of ischemic cardiomyopathy for prognostic purposes.RESULTS A more extensive CAD was independently associated with shorter survival. When the various classification schemes were compared, a modified number-of-diseased-vessels classification, in which patients with single-vessel disease and no prior history of revascularization or p myocardial infarction (MI) were classified as nonischemic, provided the most prognostic power. A definition of ischemic cardiomyopathy that incorporated this definition had more prognostic power than the traditional definition.CONCLUSIONS Angiographically diagnosed ischemic HF is associated with shorter survival than nonischemic HF. A more extensive CAD is independently associated with shorter survival, and patients with single-vessel disease and no history of MI or revascularization should be classified as nonischemic for prognostic purposes. Standardization of the definition of ischemic cardiomyopathy will be useful in the conduct and interpretation of clinical research in HF. (C) 2002 by the American College of Cardiology.