ECHOCARDIOGRAPHIC CORRELATES OF SURVIVAL IN PATIENTS WITH CHEST PAIN
ECHOCARDIOGRAPHIC CORRELATES OF SURVIVAL IN PATIENTS WITH CHEST PAIN
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DOI：
10.1016/0735-1097(94)90382-4
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发表时间：
1994-05-01
影响因子：
24
通讯作者：
LEE, TH
中科院分区：
文献类型：
--
作者：
FLEISCHMANN, KE;GOLDMAN, L;LEE, TH
目标。这项研究试图确定胸痛患者存活的超声心动图预测因素，并评估定性超声心动图数据在该队列的预后分层中的应用。超声心动图数据在急性胸痛患者预后分层中的潜在用途尚不清楚，部分原因是常规超声心动图读数的定性性质。研究组包括513名患者，他们在急诊科就诊后1个月内因急性胸痛接受了经胸二维和多普勒超声心动图检查。在首次评估时记录了这些患者的临床和心电数据，随后从官方医院报告中获得了超声心动图数据。随访存活率数据来自医疗记录或马萨诸塞州生命统计局。指数访问后平均28.5个月，102名患者(20%)死亡，其中58名(57%)的主要死因是心血管疾病。在常规可获得的定性超声心动图数据分析中，左心室大小和功能、节段性室壁运动异常、二尖瓣返流和二尖瓣结构异常的存在与总死亡率和心血管原因死亡的单变量显著相关。在校正了临床和心电图变量的多变量Cox回归分析中，严重左心功能不全(调整后的比率比3.8，95%可信区间[CI]1.9-7.5)和中重度二尖瓣反流(调整后的比率比为2.4，95%可信区间为1.5-3.7)是死亡率的独立预测因素。在非急性心肌梗死患者中，中度或重度左心功能不全和二尖瓣返流是死亡率的预测因素。超声心动图定性报告左心功能不全和二尖瓣返流是急性胸痛患者预后的独立相关因素，包括非急性心肌梗死患者。还需要更多的数据来评估这些发现的普适性以及这项诊断技术的使用意义。
Objectives. This study sought to identify echocardiographic predictors of survival in patients with chest pain and to assess the utility of qualitative echocardiographic data in the prognostic stratification of this cohort.Background. The potential usefulness of echocardiographic data in prognostic stratification of patients with acute chest pain is unclear, in part because of the qualitative nature of routinely available echocardiographic readings.Methods. The study group comprised 513 patients who under went transthoracic two-dimensional and Doppler echocardiography within 1 month of emergency department visits for acute chest pain. Clinical and electrocardiographic (ECG) data were recorded for these patients at the time of their initial evaluations, and echocardiographic data were subsequently obtained from the official hospital reports. Follow-up survival rate data were obtained from medical records or the Massachusetts Bureau of Vital Statistics.Results. A mean of 28.5 months after the index visit, 102 patients (20%) had died, including 58 (57%) for whom the primary cause of death was cardiovascular. In analysis of routinely available qualitative echocardiographic data, left ventricular size and function, the presence of regional wall motion abnormalities, mitral regurgitation and structural abnormalities of the mitral valve were significant univariate correlates of both overall mortality and death from cardiovascular causes. Severe left ventricular dysfunction (adjusted rate ratio 3.8, 95% confidence interval [CI] 1.9-7.5) and moderate or severe mitral regurgitation (adjusted rate ratio 2.4, 95% CI 1.5-3.7) were independent predictors of mortality in a multivariate Cox regression analysis that adjusted for clinical and ECG variables. Moderate or severe left ventricular dysfunction and mitral regurgitation were predictors of mortality in the subset of patients without acute myocardial infarction.Conclusions. Qualitative echocardiographic reports of left ventricular dysfunction and mitral regurgitation were independent correlates of prognosis in patients with acute chest pain, including patients without acute myocardial infarction. Further data are needed to assess the generalizability of these findings and the implications for use of this diagnostic technology.