Prediction of heart failure post myocardial infarction: comparison of ejection fraction, transmitral filling parameters, and the index of myocardial performance

Following an acute myocardial infarction (MI), the development of congestive heart failure (CHF) has been associated with a reduced ejection fraction (EF), pseudonormal or restrictive diastolic filling, and an increased index of myocardial performance (IMP). STUDY OBJECTIVES: To determine the comparative predictive value of EF, transmitral filling parameters, and IMP for the development of CHF following a first MI. DESIGN AND SETTING: A retrospective analysis of consecutive echocardiographic and Doppler studies in patients admitted for their first acute MI from the years 1988 through 1992. We studied 109 patients following their first MI with two-dimensional and Doppler within 24 hours of MI. We divided patients into those who developed CHF within 15 days (43 patients) and without CHF (66 patients). RESULTS: Patients who developed CHF had greater LV dilatation, lower EF (27.7%+/- 10.2% vs 45.6%+/- 13.2%, P < 0.001), higher E/A, shorter deceleration times (DCT; 157 +/- 69 msec vs 248 +/- 105 msec, P < 0.001), and increased IMP. Utilizing multiple logistic regression, EF (strongest predictor), DCT, and IMP were predictive of CHF. Nineteen patients in the no CHF group developed late CHF and had lower EFs (30.5%+/- 13.1% vs 50.5%+/- 9.8%, P < 0.001), higher E/A and shorter DCTs (161 +/- 39 msec vs 283 +/- 103 msec, P < 0.001). EF, DCT, and E/A were predictive of late CHF in patients without initial CHF. For patients admitted with a first MI, the EF, DCT, and to a lesser extent IMP predicted who would ultimately develop CHF. An EF < 40% or a DCT < 200 msec correctly predicted CHF in 60 of 62 patients. CONCLUSION: We conclude that the early and ultimate development of CHF following a first MI were associated with an moderately reduced EF < 40%, pseudonormal diastolic filling indices, and an increased IMP.     

Characteristics and prognosis of patients with acute myocardial infarction in relation to occurrence of congestive heart failure

Congestive heart failure is one of the major symptoms accompanyingacute myocardial infarction (AMI). The study aimed to describethe occurrence, characteristics and prognosis of congestiveheart failure in AMI and to compare post-MI patients with andwithout congestive heart failure. The methods used includedbaseline characteristics, initial symptoms, electrocardiogram(ECG), mortality during hospitalization and one year follow-upin consecutive patients with AMI admitted to Sahlgrenska Hospital,Göteborg, Sweden. Congestive heart failure was observed in 51% of the cases. Patientswith congestive heart failure were older, more frequently hada history of previous cardiovascular disease, and, less frequentlyhad chest pain on admission to hospital. They had a higher occurrenceof life-threatening ventricular arrhythmias during initial hospitalization,and their mortality during one year follow-up was 39% as comparedto 17% in patients without congestive heart failure (P<0.001).This difference remained significant when correcting for differencesat baseline. Patients with severe congestive heart failure hada one year mortality of 47% vs 31% in patients with moderatecongestive heart failure (P<0.01). Signs and symptoms of congestive heart failure occur in everysecond patient admitted to hospital due to AMI, and indicatea bad prognosis, which is directly related to the severity ofcongestive heart failure.     

平衡法门控心血池显像评价不同分级前壁心肌梗死患者左室收缩及舒张功能

目的我们应用平衡法门控心血池显像技术对不同Killip分级的前壁心肌梗死患者进行左室总体和局部收缩和舒张功能参数的对比分析。方法对照组15例（G0）,前壁心肌梗死KillipⅠ级17例（G1）,前壁心肌梗死KillipⅡⅢ级12例（G2）。利用平衡法门控心血池显像技术评价3组的左室总体和局部的收缩与舒张功能。结果①左室整体收缩功能,在LVEF,ESC 2个参数中,G1比G0有显著差异（P<0.05）,G2分别比G1和G0有显著差异（P<0.05）。在PER、1/3EF、1/3ER 3个参数中,G2分别比G1和G0显著下降（P<0.05）。②左室总体舒张功能,在PFR、1/3FF、1/3FR、EDC中,G1比G0有显著差异（P<0.05）,G2分别比G1和G0有显著差异（P<0.05）。③左室局部收缩功能,在以LVREF为参数时,G1在4个节段比G0显著差异（P<0.05）,G2在所有6个节段中比G1和G0均显著下降（P<0.05）。④左室局部舒张功能,在以LVR1/3FF为参数时,G1在4个节段比G0显著下降（P<0.05）,G2在所有6个节段比G0和G1均显著下降（P<0.05）。结论前壁心肌梗死后出现心功能受损或心力衰竭的主要原因为左室重构。     

Intravenous streptokinase in acute myocardial infarction (I.S. A.M.): assessment of left ventricular function 1 and 7 months after infarction by radionuclide ventriculography

l.S.A.M. was a prospective, placebo-controlled, double-blindmulticentre trial of high-dose short-term intravenous streptokinasein acute myocardial infarction (AMI) within 6 h of the onsetof symptoms. Determination of left ventricular ejection fraction(LVEF) by radionuclide ventriculography was performed 1 and7 months after AMI in a subset of 192 patients at rest and,in 140 of them, also during exercise. Regional myocardial functionwas analysed in all 145 patients with neither a history of aprevious myocardial infarction nor revascularization proceduresor reinfarction within the 7-month follow-up period. One month after AMI, mean LVEF was higher in the streptokinasegroup in patients with anterior AMI (50±15% vs 42 ±16%,P = 0.013). This difference was more marked in the subgrouptreated within 3 h (53 ± 14% vs 42 ± 15%, P =0.004), whereas patients treated 3–6 h after the onsetof symptoms did not differ from respective controls (41 ±16%vs 41 ±18%). In patients with inferior A MI, the differencein mean LVEF was small (57±11% vs 55 ±12%, P =0.47). After anterior AMI benefit due to streptokinase therapywas preserved up to 7 months (52 ±14% vs 44 ±17%,P = 0.013). During exercise, the increase of mean LVEF was greaterin the streptokinase group at both dates, especially 7 monthsafter AMI (41 ±61% vs l.2±6.3%, P = 0.015). Instreptokinase-treated patients with anterior AMI, regional LVEFat rest was higher at both dates compared with controls, withinthe infarct zone as well as in remote myocardium. No treatment-controldifferences were demonstrable in patients with inferior AMI.During exercise, regional contractile reserve was better inthe streptokinase group within the infarct zone as well as inremote myocardium, irrespective of the site of infarction. Thus, intravenous streptokinase within 3 h after the onset ofA MI preserves global left ventricular function m anterior AMIover a period of at least 7 months. Intravenous streptokinaseimproves regional myocardial function within the infarct zoneas well as in remote areas. In inferior AMI investigation solelyat rest may underestimate the benefit of streptokinase therapy.     

Symptoms and signs of heart failure in patients with myocardial infarction: reproducibility and relationship to chest X-ray, radionuclide ventriculography and right heart catheterization

102 patients with myocardial infarction (MI) were examined by three clinicians, who independently recorded the following symptoms and signs: dyspnoea, a displaced apex beat, S3-gallop, rales, neck vein distension, hepatomegaly, and dependent oedema. Chest X-ray, radionuclide ventriculography, and (in 40 patients) right heart catheterization were carried out immediately after the physical examination. The clinicians frequently disagreed as to the presence of physical signs of heart failure in individuals. Moreover, these signs were of limited value in identifying patients with pulmonary vascular congestion on chest X-ray, reduced left or right radionuclide ventricular ejection fractions, enlarged ventricular volumes or haemodynamic evidence of ventricular dysfunction. We conclude that clinicians frequently disagree in the recognition of physical signs of heart failure, and that these signs have an unpredictable relationship to radiographic, radionuclide and haemodynamic measures of ventricular performance in patients with MI. Nevertheless, physical signs are useful in identifying patients with high risk of cardiac death.     

Left ventricular diastolic filling in patients with coronary artery disease without myocardial infarction

Left ventricular diastolic dysfunction at rest was studied in 24 patients with coronary artery disease but no evidence of previous myocardial infarction. Seven patients with normal coronary arteries were studied as control. Diastolic filling was analyzed by the serial left ventricular volume and 14 radial axes from the gravity point of the left ventricle with cine left ventriculography. There were no differences in the systolic function between coronary artery disease and the normal control. Peak filling rate was decreased significantly in the groups with left anterior descending artery disease (LAD, p less than 0.05) and multivessel disease (MVD, p less than 0.05), but not in the group with right coronary artery disease (RCA). Time to peak filling rate was prolonged in each group of LAD (p less than 0.05), RCA (p less than 0.05), and MVD (p less than 0.001), compared with controls. The time-volume curve showed disturbed rapid filling in the LAD and RCA groups, and also both depressed rapid and slow filling in the MVD group. In the LAD group, the filling fraction was decreased significantly at the time of 25% of the diastolic period (p less than 0.001) and radial distension to the anterior wall was decreased at the time of 25%, 50%, and 75% of the diastolic period, compared with controls. In the RCA group, the filling fraction (p less than 0.001) and radial distension to the posterior wall were decreased only at the time of 25% of the diastolic period. In the MVD group, filling fraction and radial distension to the most wall were decreased at 25%, 50%, and 75% of the diastolic period.(ABSTRACT TRUNCATED AT 250 WORDS)     

苯那普利对急性心肌梗死心功能远期恢复的影响

目的 :探讨苯那普利对急性心肌梗死 ( AMI)心功能远期恢复的影响。方法 :选择 70例AMI患者 ,随机分为两组 ,每组 35例 ,分别给予常规治疗和常规治疗加苯那普利治疗 ( 10 mg/次 ,每日 1次 ,长期服用 )。两组分别在梗死后 4周和 6个月进行核素心肌显像及核素心室造影 ,测定心功能。结果 :在 AMI恢复期内 ,心肌灌注及心功能仍有所改善 ,苯那普利治疗组心功能改善明显优于常规治疗组。结论 :AMI患者心功能恢复需一较长时间 ,苯那普利有利于梗死后心功能的远期恢复。     

急性心肌梗死并发泵衰竭的影响因素

目的:探讨急性心肌梗死（AM I）患者并发泵衰竭的影响因素。方法:以1999年4月至2004年7月收住我院冠心病监护病房（CCU）的176例AM I患者为对象,对比分析泵衰竭组（66例）与对照组（110例,无泵衰竭）患者的病史、临床表现、并发症等特点,以Logistic多因素逐步回归分析AM I并发泵衰竭的影响因素。结果:泵衰竭组陈旧性心肌梗死病史、前壁或多部位AM I、肺部湿罗音、白细胞计数≥10×109/L、左心室射血分数≤0.5、肺炎发生率、下壁、侧壁或非Q波AM I、心肌酶峰值、住院期间病死率均与对照组有显著性差异（P<0.05或P<0.01）。Logistic多因素逐步回归分析表明,陈旧性心肌梗死病史、前壁或多部位AM I、高龄及并发肺炎是AM I患者并发泵衰竭的独立影响因素。结论:AM I患者有陈旧性心肌梗死病史、前壁或多部位AM I、高龄及并发肺炎是AM I并发泵衰竭的独立危险因素。     

老年急性心肌梗死合并急性左心衰竭和呼吸衰竭患者的机械通气治疗

目的 探讨老年急性心肌梗死合并急性左心衰竭和呼吸衰竭患者应用机械通气治疗的临床经验.方法 总结83例入选患者应用机械通气治疗的方式、病情好转率与病死率,并对未采用呼吸终末正压通气（PEEP）支持（Ⅰ组）和采用PEEP支持（Ⅱ组）的两组患者资料进行比较.结果 与治疗前比较,治疗后2 h和24 h时两组pH值、PaO2、PaO2/FiO2均明显改善（P＜0.05）,并且Ⅱ组的PaO2/FiO2改善更显著（P＜0.05）;Ⅰ组和Ⅱ组病情好转率分别为52.7%和71.1%（两组比较P＜0.05）,病死率分别为47.3%和37.8%（两组比较P＞0.05）,均明显低于文献报道.结论 及早提供机械通气并用PEEP支持治疗对改善老年急性心肌梗死合并急性左心衰竭和呼吸衰竭的病情是非常重要的.     

Congestive heart failure with preserved left ventricular systolic function after acute myocardial infarction: clinical and prognostic implications

AIMS: To characterise the prevalence, in-hospital complications, management, and long-term outcome of patients with congestive heart failure but preserved left ventricular systolic function after acute myocardial infarction. METHODS: 3166 consecutive patients screened for entry in the Bucindolol Evaluation in Acute Myocardial Infarction Trial with definite acute myocardial infarction and echocardiographic assessment of left ventricular systolic function were included between 1998 and 1999 in this prospective observational study. Main outcome measures were occurrences of in-hospital complications and all cause mortality. RESULTS: Congestive heart failure was seen during hospitalisation in 1464 patients (46%), 717 patients had preserved left ventricular systolic function (wall motion index > or =1.3 corresponding to ejection fraction > or =0.40), and 732 patients had systolic dysfunction (wall motion index <1.3). One year mortality in patients with no heart failure, heart failure with preserved systolic function, and heart failure with systolic dysfunction were 6, 22 and 35%, P<0.0001. Unadjusted risk of death from all causes associated with heart failure and preserved systolic function was 3.3 (95% CI 2.8-4.0), and after adjustment for baseline characteristics and left ventricular systolic function in multivariate Cox proportional hazards analysis the risk was 2.1 (95% CI 1.7-2.6), P<0.0001. CONCLUSIONS: Congestive heart failure is frequently present in patients with preserved left ventricular systolic function, and is associated with increased risk of in-hospital complications and death following acute myocardial infarction.     

In-hospital heart failure, first-year ventricular dilatation and 10-year survival after acute myocardial infarction

BACKGROUND: Little is known about the factors that determine long-term prognosis in patients who have survived the first year after acute myocardial infarction (AMI). AIMS: To study the influence of left and right ventricular (LV and RV) dilatation during the first year after AMI on subsequent 10-year survival in comparison with in-hospital heart failure and other established prognostic indices. METHODS: Radionuclide ventriculography was performed before the era of thrombolysis and post-infarction ACE-inhibition in 57 patients with AMI at hospital discharge and again 1 year later, and compared with survival the ensuing 10 years. RESULTS: After 1 year significant LV-dilatation (>20%) had occurred in 32 (56%) patients. One year after the re-investigation the mortality in these was 19% vs. 0% in patients without dilatation (P=0.02); after 5 years the difference was 38 vs. 12% (P=0.02), whereafter it declined and became insignificant at 10 years. Neither RV-dilatation, nor LVEF determined at discharge or at the 1-year reinvestigation influenced long-term survival. In contrast, clinical heart failure recorded during the hospital stay had a sustained negative influence on long-term survival. CONCLUSION: Progressive LV dilatation after discharge and clinical heart failure during the hospital stay are both determinants of late survival after AMI, whereas LV ejection fraction at hospital discharge or 1 year later has little, if any, effect on survival beyond 1-year post-AMI.     

急性ST段抬高心肌梗死患者住院期间并发泵衰竭的影响因素分析

目的探讨影响急性ST段抬高心肌梗死（STEMI）患者住院期间并发泵衰竭的因素。方法根据急性心肌梗死泵衰竭Killip临床分级标准将首次发生且发病6h内入院的263例（男203例，女60例，年龄20-90岁）。急性STEMI患者分为心功能异常组和心功能正常组，记录患者临床资料，采用酶联免疫吸附法（ELISA）测定血清白介素6（IL-6）等炎性标记物水平。结果住院期间并发泵衰竭的STEMI患者年龄（P〈0．001）、入院心率（P=0．003）、女性比例（P=0．013）、合并糖尿病史（P=0．023）以及IL-6（P〈0．001）和可溶性白细胞分化抗原40配体（P=0．01）水平均显著高于心功能正常组。Spearman＇s相关分析显示IL-6与肌酸激酶、肌钙蛋白Ⅰ峰值呈显著正相关（均P〈0．05）。多因素Logistic回归分析得出年龄、入院心率和IL-6是影响急性STEMI住院期间并发泵衰竭的独立因素。结论IL-6水平与急性STEMI住院期间并发泵衰竭独立相关，提示IL-6可提供独立于传统危险因素的预后信息辅助急性STEMI的危险分层。     

急性ST段抬高型心肌梗死患者血浆微小核糖核酸-208a水平对并发急性心力衰竭的预测价值

目的:探讨血清微小核糖核酸-208a(miR-208a)表达水平对急性ST段抬高型心肌梗死(STEMI)患者并发急性心力衰竭的预测关系。方法:连续性收集2018年1月至2019年6月,就诊于我科的152例急性STEMI患者纳入病例组,并随机选择同期在我院行健康体检的志愿者60例为对照组。根据发病48 h内是否发生急性心力衰竭(AHF)将病例组分为AHF亚组和非AHF亚组。采用实时荧光定量PCR(RT-qPCR)法检测血浆miR-208a的相对表达水平。结果:病例组血浆miR-208a相对表达水平显著高于对照组(Z=10.919,P=0.000)。AHF亚组血浆miR-208a相对表达水平显著高于非AHF亚组(Z=9.573,P=0.000)。Pearson相关性分析结果显示,病例组患者血浆miR-208a相对表达水平与BNP、hsCRP和cTnI均呈正相关关系(r=0.612,P=0.000;r=0.447,P=0.000;r=0.378,P=0.000)。二分类Logistic回归分析结果显示血浆miR-208a相对表达水平是急性STEMI患者并发AHF的危险因素(OR=2.118,95%CI 1.127~3.982,P=0.007)。血浆miR-208a预测AHF的AUC为0.896(0.844,0.948),cut-off值为32.00,对应的敏感性和特异性分别为88.4%和83.3%。结论:急性STEMI患者血浆miR-208a表达水平显著升高,且可能是并发AHF的危险因素。     

老年左室舒张性心力衰竭超声心动图观察

目的评价老年左室舒张性心力衰竭超声左心形态、功能的特点。方法对核素心室造影证实的４０例左室舒张性心力衰竭（ＬＶＤＨＦ）及３０例左室收缩性心力衰竭（ＬＶＳＨＦ）进行超声心动图检查，并以２０例正常人为对照组（ＣＧ）。结果ＬＶＤＨＦ组左房内径、室间壁及左室后壁厚度增加，左室内径不大，左室舒张功能参数减低，而左室收缩功能参数正常。ＬＶＳＨＦ组左室内径明显增加，左室收缩、舒张功能参数均异常。结论老年ＬＶＤＨＦ超声心动图特点为左房内径扩大、室壁增厚、左室内径不大，左室收缩功能正常，而左室舒张功能异常。     

米力农治疗急性心肌梗死并发急性左心衰竭的临床观察

目的评价米力农治疗急性心肌梗死并发急性左心衰竭的疗效及安全性。方法2005年1月2006年4月在沈阳军区总医院心内科诊断急性心肌梗死并发急性左心衰的住院患者120例,随机分为2组,每组60例,心功能均为Killip ⅢⅣ级,对照组给予常规抗心衰治疗,米力农组在常规治疗的基础上加用米力农0.5μg/（kg.min）静脉滴注5 h,每日1次,应用7 d。观察患者用药前后的症状变化、心功能级别及不良反应。结果米力农组心功能改善总有效率为88%,对照组为70%,两组总有效率有显著差异（P<0.05）。米力农组无明显药物不良反应。结论米力农治疗急性心肌梗死并发急性左心衰疗效确切、安全可靠。     

静脉注射艾司洛尔治疗急性心肌梗死并发急性心力衰竭的疗效及安全性

目的探讨静脉注射艾司洛尔治疗急性心肌梗死(AMI)并发急性心力衰竭(AHF)的临床疗效。方法入选11例AMI患者并发AHF、心功能KillipⅡ～Ⅲ级,在常规标准抗缺血、抗心力衰竭治疗效果欠佳,且伴有血压和心率较基线水平升高的条件下,给予静脉注射艾司洛尔(负荷剂量0.5 mg/kg 1 min内静脉注射,继之0.05 mg.kg-1.min-1持续静脉泵入),观察患者治疗前后生命体征、临床表现及X线胸片肺淤血程度的变化。结果 (1)与治疗前比较,11例患者接受静脉注射艾司洛尔治疗(中位给药时间38.5 h)后,收缩压降低[(109±16)mm Hg比(136±18)mm Hg]、舒张压降低[(61±8)mm Hg比(77±11)mm Hg]、心率减慢[(71±11)次/min比(96±31)次/min],差异均有统计学意义(均为P<0.05);(2)11例患者经治疗后,心力衰竭症状均明显缓解,肺部啰音均明显减少,X线胸片肺淤血程度均明显减轻;(3)11例患者治疗过程中均未发生低血压、严重缓慢性心律失常等不良反应。结论对于AMI患者,若病程中发生以缺血为诱因的AHF且伴有血压、心率较基础水平升高,可在常规治疗基础上,加用静脉注射艾司洛尔,可以获得良好的临床疗效,并且无明显不良反应。     

Different prognostic impact of systolic function in patients with heart failure and/or acute myocardial infarction

AIMS: To study the prognostic importance of left ventricular systolic function in patients with heart failure (HF) and acute myocardial infarction (AMI) with respect to the presence of prior heart failure and known ischemic heart disease. METHODS: In 13,084 consecutive patients diagnosed with either AMI or HF, a medical history and an echocardiographic assessment of left ventricular systolic function by wall motion index (WMI) were obtained. Patients were divided into four groups: AMI with or without a history of HF, and primary HF (no recent AMI) with or without a history of ischemic heart disease (IHD). Mortality was assessed after nine years of follow-up. RESULTS: WMI stratified patients according to all-cause mortality in all four groups of patients (p<0.0001). For a decrease in WMI of 0.3 (corresponding to a decrease in left ventricular ejection fraction of 0.1), the hazard ratio was 1.61 (95% CI: 1.48-1.76) for AMI patients without prior HF, 1.43 (1.38-1.48) for AMI patients with prior HF, 1.26 (1.22-1.30) for primary HF patients with IHD and 1.23 (1.18-1.27) for HF patients without IHD. CONCLUSION: WMI stratifies patients with IHD and/or HF according to risk of all-cause death. The presence of HF attenuates the prognostic power of WMI.     

康复运动治疗对急性心肌梗死患者左心功能的影响

目的:探讨康复运动对急性心肌梗死伴左心衰竭患者左心功能的改善作用。方法:35例急性心肌梗死合并左心功能不全患者(LVEF 36.45±5.67)在病情平稳后进行四周康复运动治疗,康复运动前、后分别进行心脏功能评定,并于出院前进行平板运动试验。结果:所有患者均完成了住院期间康复治疗,无严重心律失常、再次心肌梗死、心功能恶化等严重心脏病事件发生。左室收缩功能:LVEF,每搏量,心搏出量,均有明显增加,P<0.01。26例完成平板运动试验,运动贮量为5.56±1.23METs。结论:康复运动治疗能明显改善急性心肌梗死患者的左心功能及生活质量,促进社会与职业的回归。     

急性下壁ST段抬高型心肌梗死患者左心衰竭的危险因素分析

目的 探讨急性下壁ST段抬高型心肌梗死患者发生左心衰竭的影响因素,为临床防治措施的制定提供依据.方法 将沧州市人民医院2013年1月至2018年1月收治的534例急性下壁ST段抬高型心肌梗死患者作为此次研究对象,回顾性分析这些患者的临床病历资料,并查阅患者病史等,将发生心力衰竭的患者(162例)作为观察组,将未发生心力...