Limitations and advantages of the ejection fraction for defining high risk after acute myocardial infarction.
Limitations and advantages of the ejection fraction for defining high risk after acute myocardial infarction.
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射血分数用于定义急性心肌梗死后高风险的局限性和优点。
DOI：
10.1016/s0002-9149(86)80002-9
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
RossJr,J
中科院分区：
文献类型：
--
作者：
Ahnve,S;Gilpin,E;Henning,H;Curtis,G;Collins,D;RossJr,J
已知左心室 (LV) 射血分数 (EF) 与急性心肌梗死 (AMI) 后的预后相关，但其单独作用以及与其他因素结合在高危人群定义中的作用尚未得到充分说明。最近的几项多中心研究强调，LVEF 与动态心电图期间心室异位活动的特征一起定义了长达 3 年内死亡高风险的群体。然而，这些高风险群体仅占总体的一小部分（低于 7.5%），并且未能包括 75% 或更多（低于 25% 特异性）的观察到事件。在我们的研究中，在一项合作研究中，750 名 AMI 患者在接近出院时测定了 LVEF。单独使用时，LVEF 低于 0.45 可以最好地定义高风险群体（占人口的 39%），对 1 年总心脏死亡率产生 62% 的敏感性和 64% 的特异性；仅对猝死的敏感度就达到 77%。在与其他因素一起进行的多变量分析中，LVEF 是一个独立的预测因子，但 LV 功能障碍的其他标志物在 LVEF 之前进入，对总心脏死亡的敏感性相似，但特异性更高 (75%)。当 LVEF 低于 0.45 与复杂心律失常的存在一起定义高危组（占人口的 19%）时，敏感性下降至 39%，特异性增加至 84%。因此，LVEF 是 AMI 后风险评估多变量分析的一种简单而有效的替代方法。与基于 LVEF 和复杂心律失常的方法相比，它更加敏感，并且产生规模更合理的高风险组。
Left ventricular (LV) ejection fraction (EF) is known to be related to prognosis after acute myocardial infarction (AMI), but its role alone and in combination with other factors in the definition of a high-risk group has not been adequately specified. Several recent multicenter studies emphasize that LVEF together with features of ventricular ectopic activity during ambulatory electrocardiography define a group at high risk for death for up to 3 years. However, these high-risk groups comprised only a small fraction of the population (less than 7.5%) and failed to include 75% or more (less than 25% specificity) of observed events. In our study, LVEF was determined close to the time of hospital discharge in 750 patients with AMI enrolled in a collaborative study. Used alone, an LVEF of less than 0.45 best defined a high-risk group (39% of the population) yielding 62% sensitivity and 64% specificity for total cardiac mortality by 1 year; it was 77% sensitive for sudden death alone. In a multivariate analysis together with other factors, LVEF was an independent predictor, but other markers of LV dysfunction entered before LVEF with similar sensitivity for total cardiac deaths, but with increased specificity (75%). When an LVEF of less than 0.45 was used together with the presence of complex arrhythmias to define a high-risk group (19% of the population), sensitivity decreased to 39% and specificity increased to 84%. Thus, LVEF is a simple and effective alternative to multivariate analysis for risk assessment after AMI. It is more sensitive and produces a high-risk group of more reasonable size than an approach based on LVEF together with complex arrhythmias.