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Myocardial viability on echocardiography predicts long-term survival after revascularization in patients with ischemic congestive heart failure

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第7期33卷 1848-1854页

作者： Senior, R Kaul, S Lahiri, A Northwick Pk Hosp & Clin Res Ctr Dept Cardiovasc Med Harrow HA1 3UJ Middx England St Marks Hosp Dept Cardiovasc Med Harrow Middx England Med Res Inst Harrow Middx England Univ Virginia Div Cardiovasc Charlottesville VA USA

OBJECTIVES This study was conducted to evaluate the effect of revascularization on survival in patients with congestive heart failure (CHF) due to ischemic left ventricular (LV) systolic dysfunction based on the presence of myocardial viability (MV). BACKGROUND There are insufficient data regarding the survival benefit of revascularization in patients with CHF due to ischemic LV systolic dysfunction. METHODS Follow-up was obtained in 87 consecutive patients with CHF due to ischemic LV systolic dysfunction (New York Heart Association [NYHA] class II-IV;LV ejection fraction <0.35) who underwent low-dose dobutamine echocardiography (DE). MV within each of 12 myocardial segments representing the LV was defined as having either: 1) normal function or mild dyssynergy at rest;2) severe resting dyssynergy that improved on DE, or 3) worsening of function on DE except in the case of akinesia. RESULTS At a mean follow-up of 40 +/- 17 months, 37 patients had received revascularization on the basis of clinical grounds, and there were 22 (25%) cardiac-related deaths. Multivariate Cox regression analysis revealed that when patients with at least five segments showing MV underwent revascularization, mortality was reduced by an average of 93% (confidence interval of 22% to 99%), which was associated with improvement in NYHA class as well as LV ejection fraction. Patients with less than five segments showing MV who underwent revascularization land thus, showing mostly scar), and those with at least 5 segments demonstrating MV who were treated medically, had a much higher mortality. CONCLUSIONS Revascularization produces a clear survival benefit in patients with CHF due to ischemic LV systolic dysfunction who have a significant region of the LV demonstrating MV. These data may have wide-ranging implications in the management of patients with coronary artery disease whose main clinical presentation is CHF. (C) 1999 by the American College of Cardiology.

关键词：强心药/投药和剂量昼夜节律/生理学冠状血管造影术多巴酚丁胺/投药和剂量超声心动描记术运动试验随访研究心力衰竭/诊断显像心力衰竭/死亡率心力衰竭/治疗注射静脉内心肌收缩心肌缺血/诊断显像心肌缺血/死亡率心肌缺血/治疗心肌血管重建术试验预期值前瞻性研究 ROC曲线存活率心室功能障碍左/诊断显像心室功能障碍左/死亡率心室功能障碍左/治疗成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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White blood cell count and mortality in patients with ischemic and nonischemic left ventricular systolic dysfunction (an analysis of the studies of left ventricular dysfunction [SOLVD])

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第3期84卷 252-257页

作者： Cooper, HA Exner, DV Waclawiw, MA Domanski, MJ NHLBI Clin Trials Sci Res Grp Div Epidemiol & Clin Applicat Bethesda MD 20892 USA Georgetown Univ Med Ctr Div Cardiol Washington DC 20007 USA NHLBI Off Biostat Res Bethesda MD 20892 USA

We conducted a retrospective analysis of the Studies OF Left Ventricular Dysfunction (SOLVD) trials to assess the predictive value of the baseline white blood cell (WBC) count on mortality, Mortality was higher in participants with a baseline WBC count >7,000 compared to those with a baseline WBC less than or equal to 7,000 (27% vs 21%, p <0.0001), After controlling for important covariates, each increase in WBC count of 1,000/mm(3) was significantly associated with an increased risk of: all-cause mortality (relative risk [RR] 1.05, p <0.001). Overall, compared with a baseline W8C count less than or equal to 7,000, a baseline WBC count >7,000 was significantly associated with an increased risk of all-cause mortality (RR 1.22, p = 0.001), In participants with ischemic left ventricular (LV) dysfunction, a WBC count >7,000 remained significantly associated with an increased risk of all-cause mortality (RR 1.26, p <0.001), whereas in participants with nonischemic LV dysfunction there was no relation between WBC count and mortality (RR 1.08, p = 0.5). Thus, baseline WBC is an independent predictor of mortality in patients with LV dysfunction, specifically in those with ischemic cardiomyopathy. (C) 1999 by Excerpta Medica, Inc.

关键词：方差分析白细胞计数心肌缺血/血液心肌缺血/并发症心肌缺血/死亡率回顾性研究危险危险因素心室功能障碍左/血液心室功能障碍左/病因学心室功能障碍左/死亡率老年人女(雌)性人类男(雄)性中年人

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Exercise endpoints in patients with chronic heart failure

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INTERNATIONAL JOURNAL OF CARDIOLOGY 2000年第1期73卷 61-66页

作者： Clark, AL Coats, AJS Natl Heart & Lung Inst Dept Cardiac Med London SW3 6LY England

Background: Peak oxygen consumption ((V) over dot(O2)) is a powerful predictor of outcome in patients with chronic heart failure. This is not a test that is readily clinically available, We therefore sought to establish a method of assessing peak (V) over dot(O2) from non-invasively acquired data. Methods: We analysed the results from incremental treadmill exercise tests in 60 patients [aged 59.0 (S.D. 12.4) years] with chronic heart failure or left ventricular dysfunction [left ventricular ejection fraction (29.6 (15.2)%)] and 52 control subjects [aged 36.7 (12.3)]. Metabolic gas exchange during exercise was measured with a respiratory mass spectrometer. Heart rate and blood pressure were measured. Results: Peak (V) over dot(O2) was lower in patients than controls [19.9 (7.7) ml/kg/min vs. 38.3 (9.0), P<0.001]. Exercise time (r=0.84, P<0.001), heart rate at peak exercise (r=0.63, P<0.0001), change in heart rate (r=0.72, P<0.0001), rate pressure product at peak exercise (r=0.64, P<0.0001) and change in systolic blood pressure (r=0.31, P=0.002) all correlated with peak (V) over dot(O2). In a stepwise regression model, exercise time was the most powerful predictor of peak (V) over dot(O2) (r(2)=0.79). The only additional independent Variable was change in heart rate from rest to peak exercise, which increased r(2) to 0.80. In a survival analysis, measured peak (V) over dot(O2) and the peak (V) over dot(O2) estimated from exercise time and change in heart rate had similar predictive power. Conclusions: In this preliminary study, peak (V) over dot(O2) can be estimated from non-invasively acquired parameters. Estimated peak (V) over dot(O2) and measured peak (V) over dot(O2) have similar predictive power for outcome. Further work is necessary to see if estimated peak (V) over dot(O2) is widely applicable in a clinical setting. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.

关键词：年龄因素运动试验/方法运动耐量/生理学心力衰竭/诊断心力衰竭/死亡率心力衰竭/病理生理学血流动力学线性模型伦敦/流行病学监测生理学/方法氧耗量/生理学预后存活率分析心室功能障碍左/诊断心室功能障碍左/死亡率心室功能障碍左/病理生理学青少年成年人老年人女(雌)性人类男(雄)性中年人

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Prognostic value of pulmonary venous flow Doppler signal in left ventricular dysfunction - Contribution of the difference in duration of pulmonary venous and mitral flow at atrial contraction

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第4期36卷 1295-1302页

作者： Dini, FL Michelassi, C Micheli, G Rovai, D CNR Inst Clin Physiol I-56126 Pisa Italy Villamarina Hosp Unita Operat Cardiol Piombino Italy

OBJECTIVES We assessed the contribution of difference in duration of pulmonary venous and mitral flow at atrial contraction (ARd-Ad) for prognostic stratification of patients with left ventricular (LV) systolic dysfunction. BACKGROUND Although pulmonary venous flow (PVF) variables may supplement mitral flow patterns in evaluating left ventricular (LV) diastolic function, their value to the prognostic stratification of patients has not been investigated. METHODS Pulsed wave Doppler mitral and PVF velocity curves were recorded in 145 patients (mean age: 70 > years) with LV systolic dysfunction secondary to ischemic or nonischemic cardiomyopathy who were followed for 15 +/- 8 months. In 38% of patients, PVF signal was enhanced by the intravenous (IV) administration of a galactose-based echo-contrast agent. Based on E-wave deceleration time less than or equal to or >130 ms and ARd-Ad, patients were grouped into restrictive (group 1, n = 40), nonrestrictive with ARd-Ad greater than or equal to 30 ms (group 2, n = 55) and nonrestrictive with ARd-Ad <30 ms (group 3, n = 50). RESULTS During follow-up, 29 patients died from cardiac causes acid 28 were hospitalized for worsening heart failure (HF). On multivariate Cox model, ARd-Ad greater than or equal to 30 ms provided important prognostic information with regard to cardiac mortality and emerged as the single best predictor of cardiac events (cardiac mortality, hospitalization). The 24-month cardiac event-free survival was best (86.3%) for group 3;it was intermediate (37.9%) for group 2;and it was worst (22.9%) for group 1 (p < 0.0002 group 1 vs. 3;p < 0.0005 group 2 vs. 3;p < 0.0003 group 1 vs. group 2). CONCLUSIONS Assessment of ARd-Bd exhibited an independent value in the prognostic evaluation of patients with LV systolic dystfunction. Moreover, it contributed to identify patients at low, intermediate and high risk of cardiac events. (J Am Coll Cardiol 2000;36:1295-302) (C) 2000 by the American College of Cardiology.

关键词：血流速度死亡原因无病生存超声心动描记术多普勒脉冲心房/诊断显像心房/病理生理学二尖瓣/诊断显像心肌收缩/生理学预后前瞻性研究肺静脉/诊断显像存活率心室功能障碍左/诊断显像心室功能障碍左/死亡率心室功能障碍左/病理生理学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Left ventricular assist device improves survival in children with left ventricular dysfunction after repair of anomalous origin of the left coronary artery from the pulmonary artery

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ANNALS OF THORACIC SURGERY 1999年第1期67卷 169-172页

作者： del Nido, PJ Duncan, BW Mayer, JE Wessel, DL LaPierre, RA Jonas, RA Harvard Univ Dept Cardiac Surg Childrens Hosp Sch Med Boston MA 02115 USA Harvard Univ Childrens Hosp Sch Med Dept Cardiol Boston MA 02115 USA

Background. Repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in infants carries a high operative risk, particularly in infants with myocardial infarction and poor left ventricular function. The marked recovery of left ventricular function reported late after repair, however, suggests that an aggressive approach to repair should be undertaken Methods. Of 31 children undergoing primary repair of ALCAPA at our institution from 1987 to 1996, 26 were infants (6 weeks to 9 months old). All but 2 had severe left ventricular dysfunction, and 8 had moderate to severe mitral regurgitation. Seven children were unable to be weaned from cardiopulmonary bypass because of poor left ventricular function and elevated left atrial pressure. These 7 children were placed on mechanical left ventricular support using a centrifugal pump, with support ranging from 2.2 to 70.6 hours. Results. One child died shortly after the start of left ventricular assist (2.2 hours), and another died of arrhythmia within 24 hours after successful decannulation. All 5 survivors had significant improvement in left ventricular function, with 2 requiring late mitral valve repair. Conclusions. Infants with ALCAPA who have severe left ventricular dysfunction represent a higher risk group for repair. However, with use of mechanical circulatory support in those unable to be weaned from cardiopulmonary bypass, a high survival rate can be achieved with good long-term recovery. We conclude that an aggressive approach to early repair in all children with ALCAPA is warranted, regardless of the degree of left ventricular dysfunction. (C) 1999 by The Society of Thoracic Surgeons.

关键词：心肺转流术冠状血管畸形/外科学心脏辅助装置二尖瓣/外科学手术后并发症/死亡率肺动脉/畸形存活率分析通气机撤除法心室功能障碍左/病因学心室功能障碍左/死亡率女(雌)性人类婴儿男(雄)性

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Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction - Prevalence and mortality in a population-based cohort

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第7期33卷 1948-1955页

作者： Vasan, RS Larson, MG Benjamin, EJ Evans, JC Reiss, CK Levy, D NHLBI Framingham Heart Study Framingham MA 01702 USA Harvard Univ Sch Med Beth Israel Hosp Div Cardiol Boston MA USA Harvard Univ Sch Med Beth Israel Hosp Div Clin Epidemiol Boston MA USA Boston Med Ctr Cardiol Sect Boston MA USA Boston Univ Sch Med Dept Epidemiol & Prevent Med Boston MA 02118 USA Barnes Hosp St Louis MO 63110 USA NHLBI Bethesda MD 20892 USA

OBJECTIVES The purpose of this study was to assess the relative proportions of normal versus impaired left ventricular (LV) systolic function among persons with congestive heart failure (CHF) in the community and to compare their long-term mortality during follow-up. BACKGROUND Several hospital-based investigations have reported that a high proportion of subjects with CHF have normal LV systolic function. The prevalence and prognosis of CHF with normal LV systolic function in the community are not known. METHODS We evaluated the echocardiograms of 73 Framingham Heart Study subjects with CHF (33 women, 40 men, mean age 73 years) and 146 age- and gender-matched control subjects (nested case-control study). Impaired LV systolic function was defined as an LV ejection fraction (LVEF) <0.50. RESULTS Thirty-seven CHF cases (51%) had a normal LVEF;36 (49%) had a reduced LVEF. Women predominated in the former group (65%), whereas men constituted 75% or the latter group. During a median follow-up of 6.2 years, CHF cases with normal LVEF experienced an annual mortality of 8.7% versus 3.0% for matched control subjects (adjusted hazards ratio = 4.06, 95% confidence interval 1.61 to 10.26). Congestive heart failure cases with reduced LVEF had an annual mortality of 18.9% versus 4.1% for matched control subjects (adjusted hazards ratio = 4.31, 95% confidence interval 1.98 to 9.36). CONCLUSIONS Normal LV systolic function is often found in persons with CHF in the community and is in more common in women than in men. Although CHF cases with normal LVEF have a lower mortality risk than cases with reduced LVEF, they have a fourfold mortality risk compared with control subjects who are free of CHF. 1999 by the American College of Cardiology.

关键词：病例对照研究超声心动描记术随访研究心力衰竭/诊断显像心力衰竭/死亡率心力衰竭/病理生理学马萨诸塞/流行病学患病率预后前瞻性研究结果可重复性每搏输出量/生理学存活率心室功能障碍左/诊断显像心室功能障碍左/死亡率心室功能障碍左/病理生理学心室功能左/生理学成年人女(雌)性人类男(雄)性中年人

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Light-to-moderate alcohol consumption and prognosis in patients with left ventricular systolic dysfunction

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第7期35卷 1753-1759页

作者： Cooper, HA Exner, DV Domanski, MJ NHLBI Clin Trials Res Grp Bethesda MD 20892 USA Georgetown Univ Med Ctr Washington DC 20007 USA

OBJECTIVES The study evaluated the relationship between light-to-moderate alcohol consumption and prognosis in patients with left ventricular (LV) systolic dysfunction. BACKGROUND Although chronic consumption of large amounts of alcohol can lead to cardiomyopathy, the effects of light-to-moderate alcohol consumption in patients with LV dysfunction are unknown. METHODS The relationship between light-to-moderate alcohol consumption and prognosis was assessed in participants in the Studies of Left Ventricular Dysfunction (SOLVD), all of whom had ejection fraction values less than or equal to 0.35. Baseline characteristics and event rates of patients who consumed 1 to 14 drinks per week (light-to-moderate drinkers, n = 2,594) were compared with those of patients who reported no alcohol consumption (nondrinkers, n = 3,719). The association between light-to-moderate alcohol consumption and prognosis was evaluated using Cox proportional hazards analysis, controlling for baseline differences and important covariates. RESULTS Mortality rates were lower among light-to-moderate drinkers than among nondrinkers (7.2 vs. 9.4 deaths/100 person-years, p < 0.001). Among patients with ischemic LV dysfunction, light-to-moderate alcohol consumption was independently associated with a reduced risk of all-cause mortality (RR [relative risk] 0.85, p = 0.01), particularly for death from myocardial infarction (RR 0.55, p < 0.001). The risks of cardiovascular death, death from progressive heart failure, arrhythmic death, and hospitalization for heart failure were similar for light-to-moderate drinkers and nondrinkers in this group. Among patients with nonischemic LV dysfunction, light-to-moderate alcohol consumption had no significant effect on mortality (RR 0.93, p = 0.5). CONCLUSIONS Light-to-moderate alcohol consumption is not associated with an adverse prognosis in patients with LV systolic dysfunction, and it may reduce the risk of fatal myocardial infarction in patients with ischemic L

关键词：饮酒死亡原因预后回顾性研究心室功能障碍左/死亡率女(雌)性人类男(雄)性中年人

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Beta-adrenergic blocking agent use and mortality in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: A post hoc analysis of the studies of left ventricular dysfunction

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第4期33卷 916-923页

作者： Exner, DV Dries, DL Waclawiw, MA Shelton, B Domanski, MJ NHLBI Clin Trials Sci Res Grp Bethesda MD 20892 USA NHLBI Off Biostat Res Bethesda MD 20892 USA Wake Forest Univ Bowman Gray Sch Med Biostat Sect Winston Salem NC USA

OBJECTIVES This analysis was performed to assess whether beta-adrenergic blocking agent use is associated with reduced mortality in the Studies of Left Ventricular Dysfunction (SOLVD) and to determine if this relationship is altered by angiotensin-converting enzyme (ACE) inhibitor use. BACKGROUND The ability of beta-blockers to alter mortality in patients with asymptomatic left ventricular dysfunction is not well defined. Furthermore, the effect of beta-blocker use, in addition to an ACE inhibitor, on these patients has not been fully addressed. METHODS This retrospective analysis evaluated the association of baseline beta-blocker use with mortality in 4,223 mostly asymptomatic Prevention nial patients, and 2,567 symptomatic Treatment trial patients RESULTS The 1,015 (24%) Prevention trial patients and 197 (8%) Treatment trial patients receiving beta-blockers had fewer symptoms, higher ejection fractions and different use of medications than patients not receiving beta-blockers. On univariate analysis, beta-blocker use was associated with significantly lower mortality than nonuse in both trials. Moreover, a synergistic reduction in mortality with use of both a beta-blocker and enalapril was suggested in the Prevention trial. After adjusting for important prognostic variables with Cox multivariate analysis, the association of beta-adrenergic blocking agent use with reduced mortality remained significant for Prevention trial patients receiving enalapril. Lower rates of arrhythmic and pump failure death and risk of death or hospitalization for heart failure were observed. CONCLUSIONS The combination of a beta-blocker and enalapril was associated with a synergistic reduction in the risk of death in the SOLVD Prevention trial. (J Am Coil Cardiol 1999;33:916-23) (C) 1999 by the American College of Cardiology.

关键词：肾上腺素能β受体拮抗剂/副作用肾上腺素能β受体拮抗剂/治疗应用血管紧张素转换酶抑制药/副作用血管紧张素转换酶抑制药/治疗应用死亡原因药物疗法联合依那普利/副作用依那普利/治疗应用血流动力学/药物作用回顾性研究存活率心缩期/药物作用心室功能障碍左/诊断心室功能障碍左/药物疗法心室功能障碍左/死亡率心室功能左/药物作用成年人老年人女(雌)性人类男(雄)性中年人

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Relation of fibrinogen to cardiovascular events is independent of preclinical cardiovascular disease: The Strong Heart Study

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AMERICAN HEART JOURNAL 2003年第3期145卷 467-474页

作者： Palmieri, V Celentano, A Roman, MJ de Simone, G Best, L Lewis, MR Robbins, DC Fabsitz, RR Howard, BV Devereux, RB Cornell Univ Weill Med Coll New York NY USA Univ Naples Federico II Naples Italy Missouri Breaks Ind Res Timber Lake SD USA Univ Vermont Coll Med Burlington VT USA Medstar Res Inst Washington DC USA Natl Heart Long Blood Inst Bethesda MD USA

Background It is unclear whether fibrinogen predicts cardiovascular events independently of echocardiographic cardiovascular abnormalities and traditional risk factors., Methods We studied 2671 American Indians who participated in the second Strong Heart Study examination (19931995) and were observed for an average of 50 - 6 months. Participants with baseline overt coronary artery disease or. a plasma creatinine level greater than or equal ***/dL were excluded. Left ventricular hypertrophy, elevated arterial stiffness, and subnormal myocardial contractility were assessed by echocardiography. Results Prevalences of echocardiographic abnormalities and cardiovascular event rates were higher with higher fibrinogen levels. Incident cardiovascular events (n = 158) and deaths (n = 64) were more frequent in participants with elevated fibrinogen levels (>400 mg/dL) than in participants with lower fibrinogen levels, as was the prevalence of echocardiographic abnormalities (both P < .01). Incident cardiovascular fatal and nonfatal events and cardiovascular deaths were 4 and 8 times higher, respectively, in participants with both elevated fibrinogen levels and echocardiographic abnormalities than in participants with neither echocardiographic abnormalities nor elevated fibrinogen levels. However, participants with fibrinogen levels >400 mg/dL had a 2 times greater relative risk of cardiovascular events or mortality, independent of both risk factors and echocardiographic abnormalities. Conclusions in a population-based sample of adults without clinical evidence of coronary artery disease at, baseline, fibrinogen levels predicted cardiovascular events independent of traditional risk factors, left ventricular hypertrophy, elevated arterial stiffness, and subnormal myocardial. systolic function.

关键词：心血管疾病/血液心血管疾病/流行病学心血管疾病/死亡率超声心动描记术/统计学和数值数据纤维蛋白原/分析心脏病/血液心脏病/流行病学心脏病/死亡率肥大左心室/血液肥大左心室/流行病学肥大左心室/死亡率印第安人北美洲纵向研究危险因素心室功能障碍左/血液心室功能障碍左/流行病学心室功能障碍左/死亡率人类

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Comparison of echocardiography and radionuclide angiography as predictors of mortality in patients with left ventricular dysfunction (studies of left ventricular dysfunction)

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第3期84卷 299-303页

作者： Rashid, H Exner, DV Mirsky, I Cooper, HA Waclawiw, MA Domanski, MJ NHLBI Clin Trials Res Grp Bethesda MD 20892 USA NHLBI Off Biostat Res Div Epidemiol & Clin Applicat Bethesda MD 20892 USA Div Cardiol Washington DC USA Georgetown Univ Med Ctr Washington DC 20007 USA

Left ventricular (LV) systolic dysfunction, as indicated by a reduced LV ejection fraction (EF) is a potent predictor of cardiovascular mortality. Radionuclide angiography accurately and reproducibly assesses LVEF;however, echocardiography is used more frequently in clinical practice. Whether these methods predict similar mortality has not been fully investigated. We performed a retrospective analysis of patients with baseline radionuclide angiographic (RNA;n = 4,330) and echocardiographic (echo;n = 1,376) based EFs less than or equal to 0.35 who were enrolled in the Studies Of Left Ventricular Dysfunction (SOLVD) to address this hypothesis. After adjusting for important prognostic variables, the risk of death (RR 1.15;95% confidence interval 1.01 to 1.30;p = 0.03) and of cardiovascular death (RR 1.15;95% confidence interval 1.01 to 1.32;p = 0.04) was higher for patients with EGG-based EFs, To compare the 2 techniques across a range of IEF values, we divided the cohort into tertiles of EF, The adjusted risk estimates for all-cause and cardiovascular mortality were similar within each tertile. Of note, the mortality difference in patients with echo-versus RNA-based EFs was most prominent in women. Further, patients with echo-based EFs had significantly higher mortality at sites where this technique was less frequently used to assess the EF. Thus, for a given EF less than or equal to 0.35, an echo-based value was associated with a higher risk of death compared with the RNA-based method of measurement, These data suggest that EF wolves determined by echocardiography and radionuclide angiography predict different mortality and this may, in part, be related to technical proficiency as well as patient characteristics. (C) 1999 by Excerpta Medica, Inc.

关键词：死亡原因超声心动描记术试验预期值放射性核素心室显像术回顾性研究危险每搏输出量心室功能障碍左/死亡率心室功能障碍左/病理生理学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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