冠状动脉粥样硬化性心脏病患者收缩、舒张心脏功能不全对预后的影响  

Effect of cardiac systolic and diastolic dysfunction on the prognosis of patients with coronary artery disease

作　　者：辛哲梅[1] 黄宝涛[1] 黄方洋 赵振刚[1] 彭勇[1] 衡越 刘微[1] 廖延标 黄德嘉[1] 陈茂[1] 

机构地区：[1]四川大学华西医院心脏内科,成都610041 [2]四川大学华西医院全科医学科,成都610041

出　　处：《华西医学》2017年第5期705-711,共7页West China Medical Journal

基　　金：国家自然科学基金(30600607;30770877;81370219);国家高技术研究发展计划(2012AA02A510)

摘　　要：目的探究冠状动脉粥样硬化性心脏病(冠心病)患者收缩、舒张心脏功能不全对预后的影响。方法选择2008年7月—2012年6月至四川大学华西医院心脏内科进行冠状动脉造影的冠心病患者。患者在出院前行心脏彩色多普勒超声(彩超)检查,根据患者收缩和舒张心脏功能,将左心室射血分数(left ventricular ejection fraction,LVEF)<55%作为收缩性心脏功能不全的依据,将二尖瓣早期充盈峰值速率与二尖瓣早期舒张瓣环速率(the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity,E/e’)比率>15作为舒张性心脏功能不全的依据,将其分成心脏功能正常组(LVEF≥55%,E/e’比率≤15)、收缩合并舒张心脏功能不全组(LVEF<55%,E/e’比率>15)、舒张心脏功能不全组(LVEF≥55%,E/e’比率>15)和收缩心脏功能不全组(LVEF<55%,E/e’比率≤15)。随访终点为全因死亡和一次主要心血管事件(major cardiovascular event,MACE)。结果共纳入有完整心脏彩超报告的患者985例,在随访到全因死亡的平均(21.4±9.7)个月中,46例(4.7%)死亡,52例(5.4%)有1次MACE。收缩合并舒张心脏功能不全组和收缩心脏功能不全组患者有较高的36个月全因死亡率(4.8%、10.7%,P<0.001)和较高的41个月MACE发生率(8.6%、7.6%,P=0.028)。单因素分析显示,收缩合并舒张心脏功能不全组死亡率最高(P<0.05),舒张心脏功能不全组次之(P<0.05),收缩心脏功能不全组最低(P>0.05);与心脏功能正常组相比,收缩合并舒张心脏功能不全组的MACE发生率仍然最高(P<0.05),收缩心脏功能不全组次之(P<0.05),舒张心脏功能不全组最低(P>0.05)。多因素Cox回归模型分析显示与正常组相比,全因死亡风险在收缩和舒张心脏功能不全组中最高[危险比(hazard ratio,HR)=2.96,95%置信区间(confidence interval,CI)(1.34,6.54),P=0.007],紧随以收缩心脏功能不全组[HR=1.91,95%CI(0.67,5.42),P=0.224]和舒张心脏功能不全组[HR=Objective To explore the role of systolic and diastolic dysfunction in the prognosis of Chinese patients with coronary artery disease （CAD）. Methods CAD patients who underwent coronary arteriography in the Department of Cardiology of West China Hospital between July 2008 and June 2012 were included in this study. All the patients underwent color Doppler echocardiographic examination. Based on patients＇ systolic and diastolic cardiac function, left ventricular ejection fraction （LVEF） 〈55% was as the systolic dysfunction and the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity （E/e＇） 〉15 was as the diastolic dysfuntion. They were divided into normal cardiac function group （LVEF≥55%, E/e- rano≤15）, systolic and diastolic dysfunction group （LVEF〈55%, E/e＇ ratio〉 15）,diastolic dysfunction group （LVEF≥ 55%, Ele＇ ratio〉 15） and systolic dysfunction group （LVEF〈55%, E/e＇ ratio ≤ 15）. The end points of follow-up were all-cause death and a major cardiovascular event （MACE）. Results A total of 985 patients with complete echocardiographic report were included in this study. During the follow-up of （21.4±9.7） months, 46 patients （4.7%） died, and 52 （5.4%） had a MACE. Systolic dysfunction concomitant with diastolic dysfunction group and systolic dysfunction group patients had a higher risk of 36-month all-cause death （4.8%, 10.7%, P〈0.001） and a higher risk of 41-month MACE （8.6%, 7.6%, P=0.028）. Single factor analysis of all-cause death mortality showed that compared with the normal group, all-cause death mortality was the highest in systolic and diastolic dysfunction group （P〈0.05）, followed by diastolic dysfunction group （P〈0.05） and systolic dysfunction group （P〉0.05）. Single factor analysis of MACE showed that compared with the normal group, MACE was still the highest in systolic and diastolic dysfunction group （P〈0.05）, followed by systolic dysfunction group （P〈0.05）

关 键 词：冠状动脉粥样硬化性心脏病 收缩和舒张心脏功能不全 预后 

分 类 号：R541.4[医药卫生—心血管疾病]