心臟超音波檢測左心室擴大病例組成分析

Clinical Features of Patients with Echocardiogram Recognized Left Ventricular Dilated

曾盈筑(Ying-Chu Tseng) ； 廖為博(Wei-Ber Liao) ； 王克帆(Ko-Fang Wang) ； 周宏滔(Hung-Tao Chou) ； 陳復中(Fu-Chung Chen) ； 黎方中(Fong-Chung Lai) ； 高宏門(Hung-Men Kao)

《內科學誌》 32卷3期 (2021/06) Pp. 185-194

https://doi.org/10.6314/JIMT.202106_32(3).05

摘要

我們從心臟超音波找出心臟舒張期最大內徑≥53mm的左心室擴大病人加以分析，發現病人平均年紀為62歲，男性人數明顯多於女性。前6大共病症為高血壓（80%）、缺血性心臟病變（72%）、瓣膜性心臟病變（45%）、高脂血症（43%）、糖尿病（43%）和慢性腎臟病變（43%）。56%（84人）的心臟收縮期心射出率（Ejection Fraction: EF）≤40%，分析這84位EF≤40%的心臟衰竭病人發現其平均年紀為60歲;其前6大共病症與左心室擴大病人一樣，但缺血性心臟病變變成第一。心臟收縮期心射出率≤40%的84人經治療後，EF上升到50%的有34位（40%），還有50位（60%）沒顯著改善。我們治療心臟衰竭使用的藥物以乙型交感神經阻斷劑佔率86%最多（65人）；Entresto和Ivabradine以EF≤35%的66人計算，佔率分別為44%（29人）和18%（12人）。這150位病人中有44位病人有心房纖維顫動，其平均年紀為68歲，其前6大共病症與左心室擴大病人一樣，但慢性阻塞性肺疾病和甲狀腺疾病明顯增加，各占14%和9%。這44人中有10位發生腦中風，服用抗凝劑的有18人。由以上分析可知，區域醫院左心室擴大、心臟衰竭和心房纖維顫動的共病症相似且明顯可知，若能根據已知共病症積極治療，以及專業醫療團隊的急性心臟衰竭後照護，相信更能提升心臟衰竭病人的生活品質和壽命。

關鍵字

左心室擴大（Left ventricular dilatation） ； 心臟衰竭（Congestive heart failure） ； 心房纖維顫動（Atrial fibrillation） ； 經皮冠狀動脈成形術（Percutaneous transluminal coronary angioplasty）

並列摘要

We retrospectively enrolled 150 consecutive patients with echocardiogram demonstrated left ventricular end diastolic dimension equal or greater than 53mm. The mean age was 62 years and male to female ratio is 3.2. Among them, essential hypertension (80%), ischemic cardiomyopathy (72%), valvular heart disease (45%), hyperlipidemia, diabetes mellitus (43%) and chronic renal diseases (43%) were among the six leading comorbidities. 84 cases (56%) had left ventricle ejection fraction (LVEF) lower or equal to 40%. These low LVEF participants had the mean age of 60 years, the six leading comorbidities were comparable to all of the cases enrolled. Ischemic cardiomyopathy portrayed the most prevalent disease (86%). After treatment, 34 cases (40%) exhibited improvement of LVEF to or above 50%, however, 50 patients (60%) failed to display benefit. β-blockers were used in 65 (86%) patients which accounts for the majority. Entresto and Ivabradine were given to 29 (44%) and 12 (18%) among 66 patients depicted LVEF equal or lower than 35%. Atrial fibrillation (Af) was demonstrated in 44 out of 150 participants (mean age is 68 years). This group harbored same top six comorbidities. However, this group had higher incidence of chronic obstructive pulmonary disease (COPD) (14%) and thyroid disorders (9%). 18 of them took anti-coagulants and 10 patients encountered stroke. From assessment above, we noted that in mid-sized hospital, the comorbidities of left ventricular dilated, heart failure and Af can be outlined and if manage, we believe that clinical outcome can be significantly improved.