国际心血管病杂志
國際心血管病雜誌
국제심혈관병잡지
INTERNATIONAL JOURNAL OF CARDIOVASCULAR DISEASE
2009年
4期
240-243
,共4页
施根灵%张奇%张瑞岩%胡健%张建盛%张宪%何汝敏%沈卫峰
施根靈%張奇%張瑞巖%鬍健%張建盛%張憲%何汝敏%瀋衛峰
시근령%장기%장서암%호건%장건성%장헌%하여민%침위봉
急性心肌梗死%缺血性二尖瓣返流%死亡%心衰%预后
急性心肌梗死%缺血性二尖瓣返流%死亡%心衰%預後
급성심기경사%결혈성이첨판반류%사망%심쇠%예후
Acute myocardial infraction%Mitral regurgitation%Death%Heart failure%Prognosis
目的:探讨初发急性心肌梗死(AMI)患者缺血性二尖瓣返流的发生率及其对患者住院期间死亡及出院患者远期预后的影响. 方法:回顾性入选2000年1月至2006年1月间入院治疗的初发AMI患者,根据住院期间心脏超声检查结果,将患者分为二尖瓣无返流组、轻度、轻-中度、中-重度返流组,随访患者的远期预后.结果:在448例AMI患者中,急性期院内死亡者24例.住院期间心超结果发现二尖瓣返流发生率为67.2%,其中轻度返流为51.1%、轻-中度为9.4%、中一重度为6.7%.门诊或电话随访到患者268例(59.8%),平均随访(33.8±19.6)月,共发生死亡37例(13.8%),其中心源性死亡19例(7.1%),非心源性死亡18例(6.8%).经多因素回归分析,死亡与二尖瓣返流的严重程度呈正相关(RR=1.504,95%CI:1.002~2.256,P=0.049),心源性死亡与缺血性二尖瓣返流显著正相关(RR=3.088,95%CI:1.767~5.395,P<0.001),均独立于入院时心功能分级(NYHA)、左室射血分数及有无靶血管重建. 结论:缺血性二尖瓣返流在初发AMI患者中有较高的发生率,其对预测AMI患者的远期死亡有意义,建议纳入AMI预后的危险分层,指导今后的临床治疗.
目的:探討初髮急性心肌梗死(AMI)患者缺血性二尖瓣返流的髮生率及其對患者住院期間死亡及齣院患者遠期預後的影響. 方法:迴顧性入選2000年1月至2006年1月間入院治療的初髮AMI患者,根據住院期間心髒超聲檢查結果,將患者分為二尖瓣無返流組、輕度、輕-中度、中-重度返流組,隨訪患者的遠期預後.結果:在448例AMI患者中,急性期院內死亡者24例.住院期間心超結果髮現二尖瓣返流髮生率為67.2%,其中輕度返流為51.1%、輕-中度為9.4%、中一重度為6.7%.門診或電話隨訪到患者268例(59.8%),平均隨訪(33.8±19.6)月,共髮生死亡37例(13.8%),其中心源性死亡19例(7.1%),非心源性死亡18例(6.8%).經多因素迴歸分析,死亡與二尖瓣返流的嚴重程度呈正相關(RR=1.504,95%CI:1.002~2.256,P=0.049),心源性死亡與缺血性二尖瓣返流顯著正相關(RR=3.088,95%CI:1.767~5.395,P<0.001),均獨立于入院時心功能分級(NYHA)、左室射血分數及有無靶血管重建. 結論:缺血性二尖瓣返流在初髮AMI患者中有較高的髮生率,其對預測AMI患者的遠期死亡有意義,建議納入AMI預後的危險分層,指導今後的臨床治療.
목적:탐토초발급성심기경사(AMI)환자결혈성이첨판반류적발생솔급기대환자주원기간사망급출원환자원기예후적영향. 방법:회고성입선2000년1월지2006년1월간입원치료적초발AMI환자,근거주원기간심장초성검사결과,장환자분위이첨판무반류조、경도、경-중도、중-중도반류조,수방환자적원기예후.결과:재448례AMI환자중,급성기원내사망자24례.주원기간심초결과발현이첨판반류발생솔위67.2%,기중경도반류위51.1%、경-중도위9.4%、중일중도위6.7%.문진혹전화수방도환자268례(59.8%),평균수방(33.8±19.6)월,공발생사망37례(13.8%),기중심원성사망19례(7.1%),비심원성사망18례(6.8%).경다인소회귀분석,사망여이첨판반류적엄중정도정정상관(RR=1.504,95%CI:1.002~2.256,P=0.049),심원성사망여결혈성이첨판반류현저정상관(RR=3.088,95%CI:1.767~5.395,P<0.001),균독립우입원시심공능분급(NYHA)、좌실사혈분수급유무파혈관중건. 결론:결혈성이첨판반류재초발AMI환자중유교고적발생솔,기대예측AMI환자적원기사망유의의,건의납입AMI예후적위험분층,지도금후적림상치료.
Objective:To investigate the incidence and in-hospital or long-term prognosis of pa-tients with ischemic mitral regurgitation (IMR) after first acute myocardial infarction (AMI). Methods: Retrospective analysis of 448 patients who admitted to our hospital for first acute myocardial infarction from Jan. 2000 to Jan. 2006. According to their eehocardiographic findins, patients with MR was assigned to different groups including no, mild, mild to moderate, and moderate or severe MR, and them were followed respectively. Results:24 patients died in hospital. Mitral regurgita-tion was present in 67. 6% patients, of which mild MR was 51.1%, mild to moderate was 9. 4% and moderate or severe was 6. 7%. During an average of (33.8 ± 19. 6) months, 268 patients were fol-lowed up, and 37 patients were dead, of whom 19 died of cardiovascular disease. Multivariate analy-sis revealed that there was a graded positive association between the presence and severity of MR and death (RR = 1. 504, 95% CI:1. 002~2.256, P = 0. 049), and cardiac death was significantly relatedto MR (RR = 3.088 95 % CI: 1. 767~ 5. 395, P<0. 001), independently of NYHA, LVEF and TLR. Conclusion:MR is frequent and often silent after AMI. It carries information to predict long-term prognosis after AMI, independently of NYHA,LVEF and TLR. These findings suggest that the as-sessment of MR should be included in post-Ml risk stratification in order to improve clinical treat-meat.