불안정형 협심증 및 급성 비ST절 상승 심근경색증 환자에서 심부전 발생 예측 인자 = Predictive Factors for Heart Failure in Patients with Unstable Angina andAcute Non-ST Elevation Myocardial Infarction

다국어 초록 (Multilingual Abstract)

Background and Objectives ：Besides the acute coronary syndrome (ACS), the left ventricular failure (LVF) is the next important determinant of morbidity and mortality after acute coronary syndrome (ACS). The (UA) or acute non -ST elevation myocardial infarction (NSTEMI). Subjects and Methods ：179 patients (60.4 ±11.6 years, 121 male) who underwent diagnostic coronary angiography under the diagnosis of UA/NSTEMI between January and December, 2000, in the Chonam National University Hospital Heart Center were en -features, initial electrocardiogram, laboratory findings and coronary angiographic findings. Results：Unstable angina was clinically diagnosed in 124 patients, and NSTEMI in 55 patients. During a 12-month folow -up period, les than 40% of the left ventricular ejection fraction (EF), a low amount, was observed in 28 patients (15.7%). In diabetic patients, the incidence of LVF was significantly higher than in non -Patients with elevated C -reactive protein (CRP) or positive troponin I had LVF more frequently (p<0.05). On the initial electrocardiogram, the total summation of ST segment change inversely correlated with EF (p<0.05). Patients whose QT dispersion was longer than 80 ms had a higher incidence of LVF (p<0.05). Coronary angio -graphic findings of total occlusion corelated with the development of LVF (p<0.05), but not with other charac -teristics. On multiple logistic regression analysis, high CRP level (p=0.024), summation of ST change (p=0.02 1), Conclusion ：Elevated CRP, sumation of ST change and total coronary artery occlusion are important predictive factors for LVF in UA/NSTEMI.

국문 초록 (Abstract)

배경 및 목적： 내원 당시에 정상적인 좌심실 기능을 보였던 급성 관상동맥 증후군 환자인 UA 혹은 NSTEMI 환자에서 좌Korean Circulation J 2004;34(5):459-467 466 심실 부전을 예측할 수 있는 다양한 임상적 및 검사 소견 인자에 대해 알아보고자 하였다. 방 법： 2000년 1월부터 12 월까지 전남대학교병원 심장센터에 UA 혹은 NSTEMI로 입원하였던 환자 중 정상적인 좌심실 기능을 보였고 관상동맥 조영술을 시행한 환자 중 179예(60.4 ± 1.6세, 남 121예, 여 58예)를 대상으로 하여 12개월간 장기적인 임상 관찰을 통하여 좌심실부전 발생 여부에 관한 임상적 특징, 기저 심전도 소견, 검사실 소견 및 관상동맥 조영술상 병변의 등의 예측인자들을 비교하였다.
결 과：
대상 환자 중에서 164예(91.6%)가 관상동맥 조영술
에서 유의한 협착을 보였다. 좌심실 부전이 발생한 환자
는 28예(15.7%)이었으며, 좌심실 구혈률은 정상 범위
에 있으나, 국소 심실벽 운동이상을 보이는 경우는 47
예(26.4%)였다. 당뇨병 환자에서 좌심실 부전의 발생
이 유의하게 많았고(p<0.05) troponin I 혹은 troponin
T가 양성이고 CRP가 증가한 환자에서 심부전이 발생
할 확률이 높았으며(p<0.05), 심부전이 있는 군에서 troponin
I 수치가 유의하게 높았다(p<0.05). 기저 심전도
에서 ST분절의 상승과 하강이 동시에 있는 경우에 좌
심실 부전이 발생할 확률이 가장 높았으며 ST분절의
상승-하강 폭의 총합은 좌심실 부전 및 좌심실 구혈률
과 유의한 관계를 보였다(p<0.05). 또한 QT 분산(가장
큰 QT값과 가장 작은 QT값의 차)이 80 ms이상인 군
에서 심부전 발생 가능성이 높아짐을 알 수 있었다. 관
상동맥 조영술에서 재관류 이전 관상동맥 완전 폐쇄 여
부와 심부전의 발생은 유의한 관계를 보였으나(p<0.05),
협착이 있는 혈관의 수, ACC/AHA 병변의 분류, 좌전
행지 포함여부와는 관련이 없었다. 좌심실 부전과 관계
가 있는 것으로 나타난 여러 인자에 대한 다변량 분석
에서 CRP수치, ST절의 변화폭의 총합, 당뇨병 유병여
부가 좌심실 부전을 예측할 수 있는 독립변인임을 알
수 있었다.
결 론：
급성 관상동맥 증후군환자 중 UA 혹은 NSTEMI 환
자에서 좌심실 부전을 예측할 수 있는 인자는 증가된
CRP수치, ST절의 변화폭의 총합, 당뇨병 등이었다.

참고문헌 (Reference)

• 1 "Will QT dispersion play a role in clinical deci-sion-making?" 7 : 777-784, 1996
• 2 "Unsuitability of corrected QT dispersion as a marker for ventricular arrhy-thmias and cardiac sudden death after acute myocardial infarction" 63 : 467-470, 1999
• 3 "The initial electrocardiogram pattern is a strong predictor of outcome in acute myocardial infarction" 51 : 301-305, 1995
• 4 "Smok-ing status at the time of acute myocardial infarction and subsequent prognosis" 110 : 535-541, 1985
• 5 "Significance of reciprocal ST depression in acute myo-cardial infarction: a study of 258 patients treated by throm-bolysis" 69 : 211-214, 1993
• 6 "Sex-based diferences in early mortality after myocar-dial infarction" 341 : 217-225, 1999
• 7 "Sex differences in early mortality after acute myocardial infarction (the Minnesota Heart Sur-vey)" 75 : 1096-1101, 195
• 8 "Sex differen-ces in management and outcome after acute myocardial infarction in the 1990s" 102 : 2484-2490, 20
• 9 "Serum interleukin-6 levelbecomes elevated in acute myocardial infarction" 24 : 579-584, 1992
• 10 "Revascularization improves survival in ischemic cardiomyopathy regardless of electrocardiographic criteria for prior small to medium myocardial infarcts" 143 : 11-17, 2002
• 11 "Protecting the ischemic and refer-fused myocsrdium in acute myocardial infarction: distant dream or near really?" 83 : 381-387, 20
• 12 "Prospective study of C-reactive protein and the risk of future cardiovascular events among aparently healthy women" 98 : 731-733, 1998
• 13 "Prognostic value of cardiac troponin T in unstable angina pectoris" 76 : 970-972, 1995
• 14 "Prognostic value of ST segment depression in acute coronary syndromes: in-sights from PARAGON-A aplied to GUSTO-IIb" 38 : 64-71, 2001
• 15 "Prognostic significanceof peripheral monocytosis after reperfused acute myocardialinfarction: a possible role for left ventricular remodeling" 39 : 241-246, 2002
• 16 "Prognostic significance of admision troponin T concen-trations in patients with myocardial infarction" 94 : 1291-1297, 1996
• 17 "Procoagulant inflammatory responses of monocytes after direct balloon angioplasty in acute myocardial infarction" 82 : 938-942, 1998
• 18 "Mortality, place and mode of death and reinfarction during a period of 5 years after acute myocardial infarction in diabetic and non-diabetic patients" 87 : 423-428, 1996
• 19 "Monocyte-related cytokines in acute myocardial infarction" 130 : 446-452, 1995
• 20 "Leukocyte capillary pluging in myocardial ischemia and reperfusion in the dog" 111 : 98-11, 1983
• 21 "Left ventricular ejection fraction determined by radionuclide ventriculography in early stage of first transmural myocar-dial infarction: relation to short term prognosis" 45 : 542-546, 1980
• 22 "Hospi-tal mortality in women and men with acute cardiac ischemia: a prospective multicenter study" 29 : 1490-1496, 197
• 23 "Gender dif-ferences in the treatment and outcome of acute myocardial infarction" 152 : 972-976, 192
• 24 "Elevated troponin I level on admission is associated with adverse outcome of primary angioplasty in acute myocardial infarction" 102 : 161-166, 2000
• 25 "Effects of gender on the number of diseased vessels and clinical outcome in Japanese patients with acute coronary syndrome" 66 : 435-440, 202
• 26 "Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes" 335 : 1342-1349, 196
• 27 "Cardiac tro-ponin T levels for risk stratification in acute myocardial ischemia" 335 : 133-141, 196
• 28 "C-reactive protein fifty years on" 1 : 653-657, 1981
• 29 "Atherosclerosis: in inflammatory disease" 340 : 115-126, 1999
• 30 "A risk model de-rived from the National Registry of Myocardial Infarction 2 database for predicting mortality after coronary artery by-pass grafting during acute myocardial infarction" 90 : 1-4, 2002