Role of 2-Dimensional Echocardiography in the Early Prognostic Evaluation of Patients with Non-ST-Elevation Myocardial Infarction Not Receiving Early Invasive Strategy

心臟超音波針對未接受再灌流治療之非ST段上昇心肌梗塞病人早期預後評估之角色

吳冠漢(Kuan-Han Wu) ； 林志泉(Chih-Chuan Lin) ； 李文輝(Wen-Huei Lee)

《Journal of Emergency Medicine, Taiwan》 9卷1期 (2007/03) Pp. 7-13

摘要

Background: The objective of this study was to validate the use of 2-Dimensional (2D) echocardiography to predict early cardiac complications in patients with non-ST-elevation myocardial infarction (NSTEMI) who do not receive early invasive strategy.
Method: We retrospectively enrolled 121 patients who had an NSTEMI from January 2003 through March 2004. We excluded patients with potentially confounding troponin I levels, echocardiographic findings, and contraindications for standard treatments. We documented the patients' demographics, risk factors for coronary artery disease, electrocardiogram and 2D echocardiographic findings obtained within 72 hours of presentation. Primary end points were cardiac complications within 7 days of presentation.
Results: Forty-two patients had cardiac complications (all-cause death, acute pulmonary edema, severe dysrhythmia, cardiogenic shock, refractory angina requiring emergency reperfusion therapy, or cardiac wall rupture). In a 16-segment model, abnormalities in the regional wall motion (involvement of 3 or more segments of the left ventricle) was statistically significant predictive of cardiac complications (P＜0.05). Compared with other patients, those with cardiac complications had worse left ventricular (LV) ejection fractions (43.21% ±15.70 vs. 56.36% ± 16.03, P＜0.001) and more segments of wall motion abnormalities (8.88 ± 6.02 vs. 4.57 ± 4.69, P＜0.001). Patients with depressed LV function (ejection fraction ＜ 40%) had more cardiac complications (P＜0.001) (OR 3.32, 95% CI 1.48-7.45). Depressed LV function had a positive predictive value for early cardiac complications of 0.79.
Conclusion: Positive 2D echocardiographic findings, including abnormalities in the regional wall motion and poor LV ejection fractions, correlated to early cardiac complications in patients with NSTEMI not receiving early invasive strategy.

關鍵字

心臟超音波 ； 非ST段上昇心肌梗塞 ； 預後 ； 併發症

並列摘要

Background: The objective of this study was to validate the use of 2-Dimensional (2D) echocardiography to predict early cardiac complications in patients with non-ST-elevation myocardial infarction (NSTEMI) who do not receive early invasive strategy.
Method: We retrospectively enrolled 121 patients who had an NSTEMI from January 2003 through March 2004. We excluded patients with potentially confounding troponin I levels, echocardiographic findings, and contraindications for standard treatments. We documented the patients' demographics, risk factors for coronary artery disease, electrocardiogram and 2D echocardiographic findings obtained within 72 hours of presentation. Primary end points were cardiac complications within 7 days of presentation.
Results: Forty-two patients had cardiac complications (all-cause death, acute pulmonary edema, severe dysrhythmia, cardiogenic shock, refractory angina requiring emergency reperfusion therapy, or cardiac wall rupture). In a 16-segment model, abnormalities in the regional wall motion (involvement of 3 or more segments of the left ventricle) was statistically significant predictive of cardiac complications (P＜0.05). Compared with other patients, those with cardiac complications had worse left ventricular (LV) ejection fractions (43.21% ±15.70 vs. 56.36% ± 16.03, P＜0.001) and more segments of wall motion abnormalities (8.88 ± 6.02 vs. 4.57 ± 4.69, P＜0.001). Patients with depressed LV function (ejection fraction ＜ 40%) had more cardiac complications (P＜0.001) (OR 3.32, 95% CI 1.48-7.45). Depressed LV function had a positive predictive value for early cardiac complications of 0.79.
Conclusion: Positive 2D echocardiographic findings, including abnormalities in the regional wall motion and poor LV ejection fractions, correlated to early cardiac complications in patients with NSTEMI not receiving early invasive strategy.

並列關鍵字

2-dimensional echocardiography ； non-ST-elevation myocardial infarction ； prognosis ； cardiac complication