Data_Sheet_1_Usefulness of Diastolic Function Score as a Predictor of Long-Term Prognosis in Patients With Acute Myocardial Infarction.pdf

Background: Left ventricular diastolic function (LVDF) evaluation using a combination of several echocardiographic parameters is an important predictor of adverse events in patients with acute myocardial infarction (AMI). To date, the clinical impact of each individual LVDF marker is well-known, but the clinical significance of the sum of the abnormal diastolic function markers and the long-term clinical outcome are not well-known. This study aimed to investigate the usefulness of LVDF score in predicting clinical outcomes of patients with AMI. Methods: LVDF scores were measured in a 2,030 patients with AMI who underwent successful percutaneous coronary intervention from 2012 to 2015. Four LVDF parameters (septal e′ ≥ 7 cm/s, septal E/e′ ≤ 15, TR velocity ≤ 2.8 m/s, and LAVI ≤ 34 ml/m2) were used for LVDF scoring. The presence of each abnormal LVDF parameter was scored as 1, and the total LVDF score ranged from 0 to 4. Mortality and hospitalization due to heart failure (HHF) in relation to LVDF score were evaluated. To compare the predictive ability of LVDF scores and left ventricular ejection fraction (LVEF) for mortality and HHF, receiver operating characteristic (ROC) curve and landmark analyses were performed. Results: Over the 3-year clinical follow-up, all-cause mortality occurred in 278 patients (13.7%), while 91 patients (4.5%) developed HHF. All-cause mortality and HHF significantly increased as LVDF scores increased (all-cause mortality–LVDF score 0: 2.3%, score 1: 8.8%, score 2: 16.7%, score 3: 31.8%, and score 4: 44.5%, p < 0.001; HHF–LVDF score 0: 0.6%, score 1: 1.8%, score 2: 6.3%, score 3: 10.3%, and score 4: 18.2%, p < 0.001). In multivariate analysis, a higher LVDF score was associated with significantly higher adjusted hazard ratios for all-cause mortality and HHF. In landmark analysis, LVDF score was a better predictor of long-term mortality than LVEF (area under the ROC curve: 0.739 vs. 0.640, p < 0.001). Conclusion: The present study demonstrated that LVDF score was a significant predictor of mortality and HHF in patients with AMI. LVDF scores are useful for risk stratification of patients with AMI; therefore, careful monitoring and management should be performed for patients with AMI with higher LVDF scores.研究背景：联合多项超声心动图参数评估左心室舒张功能（Left ventricular diastolic function，LVDF），是急性心肌梗死（acute myocardial infarction，AMI）患者不良事件发生的重要预测因子。迄今为止，各项单一左心室舒张功能标志物的临床影响已较为明确，但异常舒张功能标志物总和的临床意义及其与长期临床结局的关联仍未得到充分阐释。本研究旨在探讨左心室舒张功能评分对急性心肌梗死患者临床结局的预测价值。 研究方法：本研究纳入2012年至2015年间接受成功经皮冠状动脉介入治疗的2030例急性心肌梗死患者，对其左心室舒张功能评分进行测定。本次评分采用4项左心室舒张功能参数：室间隔e'峰流速≥7 cm/s、室间隔E/e'比值≤15、三尖瓣反流（tricuspid regurgitation，TR）流速≤2.8 m/s以及左心房容积指数（left atrial volume index，LAVI）≤34 ml/m²。每存在1项异常的左心室舒张功能参数即计1分，总左心室舒张功能评分范围为0至4分。本研究评估了不同左心室舒张功能评分与全因死亡率及心力衰竭住院（heart failure hospitalization，HHF）的关联。为比较左心室舒张功能评分与左心室射血分数（left ventricular ejection fraction，LVEF）对全因死亡率及心力衰竭住院的预测能力，本研究采用受试者工作特征（receiver operating characteristic，ROC）曲线及地标分析进行评估。 研究结果：在为期3年的临床随访中，共计278例患者（占比13.7%）发生全因死亡，91例患者（占比4.5%）出现心力衰竭住院事件。随着左心室舒张功能评分升高，全因死亡率及心力衰竭住院率均显著升高：评分为0分时全因死亡率为2.3%，1分时为8.8%，2分时为16.7%，3分时为31.8%，4分时为44.5%（p < 0.001）；心力衰竭住院率在评分为0分时为0.6%，1分时为1.8%，2分时为6.3%，3分时为10.3%，4分时为18.2%（p < 0.001）。多因素分析结果显示，左心室舒张功能评分越高，全因死亡及心力衰竭住院的校正后风险比均显著升高。地标分析结果显示，左心室舒张功能评分对长期全因死亡的预测能力优于左心室射血分数（受试者工作特征曲线下面积：0.739 vs 0.640，p < 0.001）。 研究结论：本研究证实，左心室舒张功能评分可显著预测急性心肌梗死患者的全因死亡及心力衰竭住院事件。左心室舒张功能评分可用于急性心肌梗死患者的风险分层，因此对于左心室舒张功能评分较高的急性心肌梗死患者，应予以严密监测与管理。