社区无症状左心室收缩功能障碍病人的预后

目的：探讨无症状左心室收缩功能障碍病人的预后。方法：从社区每年参加健康体检并经过心脏超声检查的2487名居民中筛选出无症状左心室收缩功能障碍（EF≤50％）92例。左心室收缩功能正常2395例，进行长达12年的随访，观察充血性心力衰竭率及死亡率。评估无症状左心室收缩功能障碍或正常左室收缩功能对充血性心力衰竭发生率或死亡率的影响，用Kaplan--Meier曲线表示，并作对数秩检验。影响预后的因素用Cox风险比例模型鉴定。结果：无症状左心室收缩功能障碍92例，患病率3．7％。无症状左心室收缩功能障碍组随访0．5～12，平均（6．1士3．0）年，检出充血性心力衰竭36例．平均年充血性心力衰竭率6．4％；随访1～12．平均（6．7±2．5）年，检出死亡病人78例，平均年死亡率12．7％。而左心室收缩功能正常组随访1～12，平均（9．4士2．3）年，检出充血性心力衰竭97例，平均年充血性心力衰竭发生率0．4％；随访1～12，平均（9．5±2．2）年，检出死亡病人261例，平均年死亡率1．1％。Kaplan—Meier检验显示两组年充血性心力衰竭率和死亡率均有显著差别（P=0．000）。Cox回归显示无症状左心室收缩功能障碍既是充血性心力衰竭的独立危险因素（HR-6．6，95%．CI3．9～11．1，P=0．000），又是死亡的独立危险因素（HR=5．3，95％CI3．7～7．5，P=0．000）。结论：无症状左心室收缩功能障碍病人充血性心力衰竭率和死亡率较高。

Prognosis of patients with asymptomatic left ventricular dysfunction in kexuecheng community of mianyang city

Objective： To study the prognosis of patients with asymptomatic left ventrieular systolic dysfunction （ALVSD） in kexuecheng community of mianyang city. Methods： A total of 2487 participants from the Kexuecheng community of Mianyang city were followed up prospectively, who underwent routine eehocardiography and were classi- fied as had normal systolic function of left ventricle （ejection fraction, EF〉50%）, or systolic dysfunction （EF≤50%）. Congestive heart failure （CHF） and death in individuals were selected as primary and secondary end points. Results： The prevalence of ALVSD （visually estimated EF≤50% without a history of CHF） was 3.7 %. The median follow up time of ALVSD was （6.7±2.5） years. During up to 12 years of follow-up, rates of CHF among subjects with normal left ventricular systolic function （EF〉50%, n= 2395） and ALVSD （n= 92） were 0.4 and 6.4 per 100 person-years, respectively. ALVSD was associated with a hazards ratio （HR） for CHF of 6.6 （95% CI 3.9 to 11.1）, when compared with individuals without ALVSD. Furthermore, rates of death among subjects with normal left ventricular systolic function and ALVSD were 1.1 and 12.7 per 100 person-years respectively. ALVSD was associated with a hazard ratio（HR） of 5.3 （95% CI 3.7 to 7.5） for death, when compared with individuals without ALVSD. Conclusion： Asymptomatic left ventricular systolic dysfunction is independent risk factor not only of CHF,but of death.