扩张型心肌病患者左心室射血分数及舒张末期内径恢复正常的相关因素分析  

Frequency and predictors of recovery of normal left ventricular ejection fraction and end-diastolic diameter in patients with dilated cardiomyopathy

作　　者：邹长虹[1] 巫雪飞 周琼[1] 张宇辉[1] 吕蓉[1] 张健[1] 

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外心血管病医院,心力衰竭中心心力衰竭监护病房,100037 [2]北京水利医院内科

出　　处：《中华心血管病杂志》2014年第10期851-855,共5页Chinese Journal of Cardiology

基　　金：“十二五”国家科技支撑计划项目（2011BAI11B02）;首都医学科学发展基金（20091005）

摘　　要：目的 分析扩张型心肌病（DCM）患者左心室射血分数（LVEF）及舒张末期内径（LVEDD）恢复正常的发生率及其预测因素.方法 连续入选2008年10月至2012年10月住院的DCM患者296例,随访至少12个月或至全因死亡及心脏移植.根据复查超声心动图结果,定义LVEF≥50％及LVEDD≤55 mm（男）或50 mm（女）为恢复正常标准.调查其发生率并分析预测因素.结果 296例DCM患者纳入本研究,中位随访时间28个月,27.4％ （81/296）的患者LVEF恢复正常,21.3％ （63/296）的患者LVEDD恢复正常,17.6％ （52/296）的患者两者均恢复正常.在两者均恢复的患者中,LVEF由（31.7±6.3）％增加至（57.5±5.2）％（P＜0.01）,LVEDD由（62.7±4.3）mm减小至（50.2±3.7） mm（P ＜0.01）.多变量logistic回归分析结果显示,心力衰竭病史短（OR=0.983,P＜0.01）、入院收缩压高（OR=1.036,P＜0.01）、基线LVEDD小（OR=0.898,P＜0.01）及LVEF高（OR=1.073,P＜0.05）与DCM患者LVEF及LVEDD均恢复正常相关.结论 部分DCM患者经过标准抗心力衰竭治疗后,LVEF及LVEDD均可恢复正常.心力衰竭病史短、入院收缩压高、基线LVEDD小或LVEF高的患者恢复的可能性大.Objective To observe the frequency and predictors of recovery of normal left ventricular ejection fraction （LVEF） and end-diastolic diameter （LVEDD） in patients with dilated cardiomyopathy （DCM）.Methods A consecutive cohort of 296 patients with DCM were reviewed and followed up for at least 12 months or to death or cardiac transplantation,to identify those with recovery of normal LVEF,defined as LVEF ≥ 50%,or recovery of normal LVEDD,defined as LVEDD ≤ 55/50 mm for male/female,or both by follow up echocardiography.Variables regarded as potentially relevant to left ventricular function and dimension recovery were evaluated to identify predictors using multivariable logistic regression analysis.Results After a median follow-up of 28 months,normal LVEF was evidenced in 81 patients （27.4%）,normal LVEDD was found in 63 patients （21.3%） and both parameters were recovered in 52 patients （17.6%）,LVEF was increased from （31.7 ±6.3）% to （57.5 ±5.2）% （P 〈0.01） and LVEDD decreased from （62.7 ± 4.3） mm to （50.2 ± 3.7） mm （P 〈 0.01） in these 52 patients.Multivariable logistic regression analysis showed that shorter symptom duration,higher systolic blood pressure at admission,smaller LVEDD and lower LVEF by echocardiography at baseline were independent predictors of subsequent recovery of normal LVEF and LVEDD.Conclusion Current therapy for heart failure could lead to recovery of normal LVEF and LVEDD in part of DCM patients,especially for DCM patients with short symptom duration,higher systolic blood pressure at admission,less enlarged LVEDD and less reduced LVEF at baseline echocardiography.

关 键 词：心肌病 扩张型 心室功能 左 

分 类 号：R542.2[医药卫生—心血管疾病]