Prevalence and prognosis of asymptomatic left ventricular diastolic dysfunction in ambulatory patients with coronary heart disease
Prevalence and prognosis of asymptomatic left ventricular diastolic dysfunction in ambulatory patients with coronary heart disease
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DOI：
10.1016/j.amjcard.2007.01.041
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发表时间：
2007-06-15
影响因子：
2.8
通讯作者：
Whooley, Mary A.
中科院分区：
文献类型：
--
作者：
Ren, Xiushui;Ristow, Bryan;Whooley, Mary A.
研究无心力衰竭（HF）病史的冠心病（CHD）非住院患者无症状左室（LV）舒张功能障碍与心血管预后的关系。左室舒张期HF预测不良心血管结局。然而，流行和。无临床心衰的冠心病患者无症状左室舒张功能障碍的预后尚不清楚。693例稳定型冠心病患者，收缩功能正常（左室射血分数>= 50%），无心衰病史。采用超声心动图对左室舒张功能进行分类，并采用Cox比例风险模型评价3年随访期间左室舒张功能障碍与心血管结局的关系。693例收缩期功能正常且无心衰病史的受试者中，455例（66%）左室舒张功能正常，166例（24%）左室轻度舒张功能不全，72例（10%）左室中度至重度舒张功能不全。多变量调整后，中度至重度左室舒张功能障碍的存在是HF住院事件（风险比为6.3,95%可信区间为2.4 ~ 16.1,p = 0.0003）和心脏病死亡（风险比为3.9,95%可信区间为1.0 ~ 14.8,p = 0.05）的强烈预测因素。综上所述，10%的射血分数正常且无心衰病史的稳定型冠心病患者存在中度至重度左室舒张功能障碍，并可预测随后因心衰住院和心脏病死亡。无症状左室舒张功能不全的患者可以通过更积极的治疗来预防或延缓心衰的发展。(c) 2007爱思唯尔公司版权所有。
The association of asymptomatic left ventricular (LV) diastolic dysfunction with cardio-vascular outcomes in ambulatory patients with coronary heart disease (CHD) and no history of heart failure (HF) was examined. LV diastolic HF predicts adverse cardiovascular outcomes. However, the prevalence and.prognosis of asymptomatic LV diastolic dysfunction in patients with established CHD in the absence of clinical HF is unknown. Six hundred ninety-three patients with stable CHD, normal systolic function (LV ejection fraction >= 50%), and no history of HF were evaluated. Echocardiography was used to classify LV diastolic function, and Cox proportional hazards models were used to evaluate the association of LV diastolic dysfunction with cardiovascular outcomes during 3 years of follow-up. Of 693 subjects with normal systolic function and no history of HF, 455 (66%) had normal LV diastolic function, 166 (24%) had mild LV diastolic dysfunction, and 72 (10%) had moderate to severe LV diastolic dysfunction. After multivariable adjustment, the presence of moderate to severe LV diastolic dysfunction was strongly predictive of incident hospitalization for HF (hazard ratio 6.3, 95% confidence interval 2.4 to 16.1, p = 0.0003) and death from heart disease (HR 3.9, 95% confidence interval 1.0 to 14.8, p = 0.05). In conclusion, moderate to severe LV diastolic dysfunction was present in 10% of patients with stable CHD with normal ejection fraction and no history of HF and predicts subsequent hospitalization for HF and death from heart disease. Patients with asymptomatic LV diastolic dysfunction may benefit from more aggressive therapy to prevent or delay the development of HF. (c) 2007 Elsevier Inc. All rights reserved.