BACKGROUND Ischemic cardiomyopathy is a high-cost, resource-intensive public health burden that is associated with a 1-year mortality rate of about 16% in western population. Different in patient ethnicity and pattern of practice may impact the clinical outcome. We aim to determine 1-year mortality and to identify factors that significantly predicts 1-year mortality of Thai patients with ischemic cardiomyopathy. METHODS This prospective multicenter registry enrolled consecutive Thai patients that were diagnosed with ischemic cardiomyopathy at 9 institutions located across Thailand. Patients with left ventricular function < 40% and one of the following criteria were included: 1) presence of epicardial coronary stenoses > 75% in the left main or proximal left anterior descending artery or coronary angiography, and/or two major epicardial coronary stenoses; 2) prior myocardial infarction; 3) prior revascularization by coronary artery bypass graft or percutaneous coronary intervention; or, 4) magnetic resonance imaging pattern compatible with ischemic cardiomyopathy. Baseline clinical characteristics, coronary and echocardiographic data were recorded. The 1-year clinical outcome was pre-specified. RESULTS Four hundred and nineteen patients were enrolled. Thirty-nine patients (9.9%) had died at 1 year, with 27 experiencing cardiovascular death, and 12 experiencing non-cardiovascular death. A comparison between patients who were alive and patients who were dead at 1 year revealed lower baseline left ventricular ejection fraction (LVEF) (26.7 ± 7.6% vs 30.2 ± 7.8%; p = 0.021), higher left ventricular end-diastolic volume (LVEDV) (185.8 ± 73.2 ml vs 155.6 ± 64.2 ml; p = 0.014), shorter mitral valve deceleration time (142.9 ± 57.5 ml vs 182.4 ± 85.7 ml; p = 0.041), and lower use of statins (94.7% vs 99.7%; p = 0.029) among deceased patients. Patients receiving guideline-recommended β-blockers had lower mortality than patients receiving non-guideline-recommended β-blockers (8.1% vs 18.2%; p = 0.05). CONCLUSIONS The results of this study revealed a 9.9% 1-year mortality rate among Thai ischemic cardiomyopathy patients. Doppler echocardiographic parameters significantly associated with 1-year mortality were LVEF, LVEDV, mitral E velocity, and mitral valve deceleration time. The use of non-guideline-recommended β-blockers rather than guideline recommended β-blockers were associated with increased with 1-year mortality. Guidelines recommended β-blockers should be preferred. TRIAL REGISTRATION Thai Clinical Trials Registry TCTR20190722002. Registered 22 July 2019. "Retrospectively registered".

中文翻译：

---

指南推荐与非指南推荐的β受体阻滞剂和多普勒超声心动图参数对泰国缺血性心肌病患者1年死亡率的影响：前瞻性多中心研究。

背景技术缺血性心肌病是高成本，资源密集型的公共卫生负担，与西方人群的1年死亡率约16％有关。患者种族和执业方式的不同可能会影响临床结果。我们旨在确定1年死亡率，并确定可显着预测泰国缺血性心肌病患者1年死亡率的因素。方法这项前瞻性多中心登记研究纳入了泰国各地9家机构中连续被诊断为缺血性心肌病的泰国患者。左心功能<40％且符合以下标准之一的患者：1）左主干或近前左降支动脉或冠状动脉造影中存在心外膜冠状动脉狭窄> 75％，和/或两个主要的心外膜冠状动脉狭窄；2）先前的心肌梗塞；3）事先通过冠状动脉搭桥术或经皮冠状动脉介入术进行血运重建；或4）与缺血性心肌病相容的磁共振成像模式。记录基线临床特征，冠状动脉和超声心动图数据。预先规定了1年临床结果。结果共有419例患者入选。三十九名患者（9.9％）在1年时死亡，其中27例因心血管疾病死亡，12例因非心血管疾病死亡。存活患者和1年死亡患者之间的比较显示，基线左室射血分数（LVEF）较低（26.7±7.6％vs 30.2±7.8％； p = 0.021），左室舒张末期容积（LVEDV）较高）（185.8±73.2 ml对155。6±64.2毫升 p = 0.014），二尖瓣减速时间更短（142.9±57.5 ml和182.4±85.7 ml； p = 0.041）和他汀类药物的使用减少（94.7％vs 99.7％； p = 0.029）。接受指南推荐的β受体阻滞剂的患者的死亡率要低于接受非指南推荐的β受体阻滞剂的患者（8.1％vs 18.2％； p = 0.05）。结论本研究结果显示泰国缺血性心肌病患者1年死亡率为9.9％。与1年死亡率显着相关的多普勒超声心动图参数是LVEF，LVEDV，二尖瓣E速度和二尖瓣减速时间。使用非指南推荐的β受体阻滞剂而不是指南推荐的β受体阻滞剂会增加1年死亡率。建议使用指南推荐的β受体阻滞剂。试验注册泰国临床试验注册中心TCTR20190722002。注册于2019年7月22日。“追溯注册”。