Coronary artery cardiomyopathy. Hemodynamic and prognostic implications.
Coronary artery cardiomyopathy. Hemodynamic and prognostic implications.
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冠状动脉心肌病。
DOI：
10.1378/chest.89.3.352
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发表时间：
1986
期刊：
影响因子：
9.6
通讯作者：
A. Iskandrian
中科院分区：
文献类型：
--
作者：
R. Fox;P. Nestico;B. J. Munley;A. Hakki;D. Neumann;A. Iskandrian
为了评价冠状动脉疾病(或冠状动脉心肌病)继发严重左心功能不全患者左心室扩大的发生率和意义，我们研究了70例射血分数小于或等于35%的单支或多支冠状动脉病变患者。没有人最近有过心肌梗死或心脏瓣膜病。排除在随访期间接受心肌血管重建术的患者。左心室舒张末容量(声学造影)<110ml/sm2者14例(20%)(组1)，大于或等于110ml/sm2者56例(80%)(组2)。两组患者在年龄、性别、糖尿病、高血压、冠状动脉病变程度、左心功能不全等方面均无差异。第1组患者有较低的肺动脉楔压(13+/-6vs22+/-10 mm Hg；p=0.0008)，较低的左室舒张末压(21+/-6vs27+/-9 mm Hg；p=0.007)，较高的左心室射血分数(31+/-2vs25+/-7%；平均随访27个月，有24例患者死于心脏原因，均在第2组。第1组的存活率显著高于第2组(Mantel-Cox，p=0.009)。对20个临床、血流动力学和血管造影变量的生存分析(COX模型)显示，射血分数(CHI2=13.6；P<0.001)和舒张末容量CHI2=4.7P=0.03是最显著的死亡预测因素。因此，微扩张型冠状动脉心肌病是一种血流动力学良好的独特疾病。从预后来看，在接受保守治疗的患者中，舒张末容量对射血分数增加了显著的预测信息。
To assess the prevalence and significance of left ventricular dilatation in patients with severe left ventricular dysfunction secondary to coronary artery disease (or coronary artery cardiomyopathy), we studied 70 patients with an ejection fraction of 35 percent or less and one-vessel coronary artery disease (n = 14) or with multivessel coronary artery disease (n = 56). None had had a recent myocardial infarction or valvular heart disease. Patients who underwent myocardial revascularization during follow-up were excluded. The left ventricular end-diastolic volume (measured by contrast ventriculography) was less than 110 ml/sq m in 14 patients (20 percent) (group 1), and was 110 ml/sq m or more in 56 patients (80 percent) (group 2). There were no differences between the two groups in age, sex, diabetes mellitus, hypertension, extent of coronary artery disease, or left ventricular asynergy. Patients in group 1 had lower pulmonary arterial wedge pressure (13 +/- 6 vs 22 +/- 10 mm Hg; p = 0.0008), lower left ventricular end-diastolic pressure (21 +/- 6 vs 27 +/- 9 mm Hg; p = 0.007), and higher left ventricular ejection fraction (31 +/- 2 vs 25 +/- 7 percent; p = 0.001) than patients in group 2. At a mean follow-up of 27 months, 24 patients had died of cardiac causes, all of whom were in group 2. Survival was significantly better in group 1 than in group 2 (Mantel-Cox, p = 0.009). Survival analysis (Cox models) of 20 clinical, hemodynamic, and angiographic variables showed that ejection fraction (chi2 = 13.6; p less than 0.001) and end-diastolic volume chi2 = 4.7; p = 0.03) were the most significant predictors of death. Thus, minimally dilated coronary artery cardiomyopathy is a distinct entity with favorable hemodynamics. Prognostically, the end-diastolic volume adds significant predictive information to the ejection fraction among conservatively treated patients.