扩张型心肌病住院患者左心室收缩功能障碍恢复和复发的发生率及其预测因素  

Recovery and relapse of left ventricular systolic dysfunction in hospitalized patients with dilated cardiomyopathy： frequency and related factors

作　　者：张健[1] 邹长虹[1] 黄燕[1] 周琼[1] 张宇辉[1] 吕蓉[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监护病房,100037

出　　处：《中华心血管病杂志》2015年第12期1034-1039,共6页Chinese Journal of Cardiology

基　　金：“十二五”国家科技支撑计划（2011BA111B02）;首都医学科学发展基金（20091005）

摘　　要：目的 分析扩张型心肌病（DCM）住院患者左心室收缩功能障碍（LVSD）恢复和复发的发生率及其预测因素.方法 入选2008年10月至2013年12月在阜外心血管病医院住院且出院后复查超声心动图的DCM患者382例,随访至2014年12月或全因死亡或心脏移植.随访过程中,将左心室射血分数（LVEF）绝对值较基线值提高＞10％且LVEF＞ 50％定义为LVSD恢复,而将恢复后LVEF再次＜45％定义为LVSD复发.结果 382例DCM患者平均随访（28±17）个月,其中114例（29.8％）LVSD恢复,这些患者的LVEF由（31.6±6.0）％升至（55.8±3.7）％（P＜0.01）,左心室舒张末期内径（LVEDD）从（65.1±6.7） mm缩小至（53.5 ±4.9） rmm（P＜0.01）.多变量logistic回归分析显示,心力衰竭病史（OR=0.986,P＜0.01）、基线收缩压水平（OR=1.026,P＜0.01）、基线LVEDD（OR=0.938,P＜0.01）及LVEF水平（OR=1.038,P＜0.05）是LVSD恢复的独立预测因素.LVSD恢复的患者中有88例又继续随访了（24±13）个月,其中17例（19.3％） LVSD复发,这些患者的LVEF从（54.3±2.6）％降至（36.6±5.1）％（P＜0.01）,LVEDD从（57.5±4.2） mm扩大至（62.8±6.8）mm（P ＜0.01）.多变量分析显示,LVSD恢复时LVEDD较基线改善程度小是LVSD复发的独立预测因素.结论 DCM住院患者中约30％ LVSD可恢复,心力衰竭病史、人院收缩压水平、基线LVEDD及LVEF水平是其独立预测因素.LVSD恢复的患者中又有约20％可复发,复发与否与LVSD恢复时LVEDD改善程度相关.Objective To investigate the frequency and predictors of recovery and relapse of left ventricular systolic dysfunction （LVSD） in hospitalized patients with dilated cardiomyopathy （DCM）.Methods Patients with DCM hospitalized in Fuwai Hospital from October 2008 to December 2013 with repeat echocardiography results after discharge were reviewed and followed to December 2014 or until all-cause death or cardiac transplantation.Rate of recovery of LVSD,defined as an absolute increase in left ventricular ejection fraction （LVEF） of 〉 10% to a level of 〉50% on follow-up,and those with relapse of LVSD,defined as a decrease in LVEF to a level of 〈 45% after initial recovery was obtained and related factors affecting LVSD recovery and relapse were analyzed.Results After a mean follow-up of （28 ± 17） months,recovery of LVSD was evidenced in 114 of 382 patients （29.8%）,LVEF increased from （31.6 ± 6.0） % to （55.8 ±3.7） % （P 〈0.01） and left ventricular end-diastolic diameter （LVEDD） decreased from （65.1 ± 6.7） mm to （53.5 ± 4.9） mm （P 〈 0.01） in these patients.Multiple logistic regression analysis showed that symptom duration of heart failure （OR =0.986,P 〈 0.01）,systolic blood pressure （SBP） （OR =1.026,P 〈0.01）,LVEDD （OR =0.938,P 〈0.01） andLVEF （OR =1.038,P 〈0.05） at admission were independent predictors of LVSD recovery.During the subsequent follow-up of （24 ± 13） months after initial recovery,17 of 88 patients （19.3%） suffered a relapse of LVSD,LVEF decreased from （54.3±2.6） % to （36.6±5.1） % （P〈0.01）,LVEDD increased from （57.5±4.2） mmto （62.8± 6.8） mm （P 〈0.01） in these patients.Multiple logistic regression analysis showed that less decrease in LVEDD at initial recovery of LVSD was independent predictor of LVSD relapse.Conclusions About 30% hospitalized patients with DCM experienced LVSD recovery in this patient cohort.Symptom duration of heart failure,SBP,LVEDD and LVEF on admission were predi

关 键 词：心肌病 扩张型 功能恢复 复发 预测 

分 类 号：R542.2[医药卫生—心血管疾病]