新发扩张型心肌病患者药物治疗后左心室逆重构的发生率及预测因素  

Prevalence and predictors of left ventricular reverse remodeling in patients with recent onset dilated cardiomyopathy on tailored medical therapy

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 心血管疾病国家重点实验室 阜外医院心力衰竭中心,100037

出　　处：《中华心血管病杂志》2016年第4期315-320,共6页Chinese Journal of Cardiology

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

摘　　要：目的 分析新发扩张型心肌病患者药物治疗后左心室逆重构的发生率及预测因素.方法 入选2008年10月至2013年12月在阜外医院心力衰竭中心住院的新发扩张型心肌病患者137例,随访至2014年12月或全因死亡或心脏移植.患者住院期间及出院后均给予指南推荐的标准抗心衰药物治疗.根据复查超声心动图结果,定义左心室射血分数（LVEF）绝对值较基线提高≥10％且LVEF≥50％,同时左心室舒张末期内径（LVEDD）绝对值较基线缩小≥10 mm且LVEDD≤55 mm为左心室逆重构,调查左心室逆重构的发生率.收集患者首次入院时（基线）的临床和超声心动图指标,采用多变量logistic回归分析方法分析左心室逆重构的基线预测指标.结果 137例新发扩张型心肌病患者超声心动图中位随访25个月（范围6-64个月）后,46例（33.6％）患者发生左心室逆重构,其LVEF由基线的（30.8±5.9）％提高至随访的（59.7±4.6）％（P＜0.01）,LVEDD由基线的（63.8±4.0）mm缩小至随访时（49.6±3.5）mm（P ＜0.01）.多变量logistic回归分析结果显示,入院收缩压[每升高10 mmHg（1 mmHg =0.133 kPa）,OR=1.379,P＜O.01]、心电图QRS间期（≤100 ms比＞ 100 ms,OR=2.959,P＜0.01）及入院LVEDD（每增加5 mm,OR=0.684,P＜0.01）3个基线临床指标是新发扩张型心肌病患者发生左心室逆重构的独立预测因素.结论 约1/3的新发扩张型心肌病患者经过标准抗心衰药物治疗可发生左心室逆重构.入院收缩压高、心电图QRS间期短及基线LVEDD小的患者发生左心室逆重构的可能性大.Objective To observe the frequency and explore the predictors of left ventricular reverse remodeling（LVRR） in patients with recent onset dilated cardiomyopathy （RODCM） on tailored medical therapy.Methods Patients hospitalized with RODCM in Heart Failure Care Unit in Fuwai Hospital from October 2008 to December 2013 were reviewed and followed up to December 2014 or death or cardiac transplantation.Patients were treated with tailored medical therapy.LVRR was defined as an at least 10% increase in left ventricular ejection fraction（LVEF） and to a final level of ≥ 50% and an at least 10 mm decrease in left ventricular end-diastolic diameter （LVEDD） and to a final level of ≤ 55 mm on repeat echocardiogram.Clinical,electrocardiogram and echocardiographic variables at baseline were evaluated to identify predictors of LVRR by multivariable logistic regression analysis.Results A total of 137 patients with RODCM were enrolled in this analysis.During a median follow-up period of 25 months （range 6 to 64 months） with repeat echocardiography,46 patients（33.6%） were defined as LVRR,LVEF increased from （30.8±5.9） % at baseline to（59.7 ±4.6） % on follow-up（P〈0.01） and LVEDD decreased from （63.8 ±4.0） mm at baseline to （49.6 ±3.5） mm on follow-up（P 〈0.01） in these patients.Multivariable logistic regression analysis showed that higher systolic blood pressure at presentation （per 10 mmHg （1 mm Hg =0.133 kPa） increase,OR =1.379,P 〈 0.01）,shorter QRS interval （≤ 100 ms vs.〉 100 ms,OR =2.959,P 〈 0.01） and smaller LVEDD （per 5 mm increase,OR =0.684,P 〈 0.01） at baseline were independent predictors of LVRR.Conclusins On current tailored medical therapy,LVRR could be achieved in about one third of patients with RODCM.Patients with higher systolic blood pressure on admission,shorter QRS interval and smaller LVEDD at baseline are associated with a higher likelihood of occurrence of LVRR.

关 键 词：心肌病 扩张型 左心室逆重构 

分 类 号：R542.2[医药卫生—心血管疾病]