急性心肌梗死后射血分数保留型心力衰竭患者远期预后影响因素分析  

Analysis of independent predictors for long-term prognosis in patients with heart failure with preserved ejection fraction after acute myocardial infarction

作　　者：王新宏[1] 朱参战[1] 万招飞 刘小军 薛嘉虹 WANG Xin-hong;ZHU Can-zhan;WAN Zhao-fei;LIU Xiao-jun;XUE Jia-hong(Department of Cardiology Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004, China)

机构地区：[1]西安交通大学第二附属医院心内科,陕西省西安市710004

出　　处：《中国心血管病研究》2019年第8期715-718,共4页Chinese Journal of Cardiovascular Research

基　　金：陕西省重点研发计划一般项目(2018SF-105).

摘　　要：目的 探讨影响心肌梗死后射血分数保留型心力衰竭(HFpEF)患者主要不良心血管事件(major adverse cardiovascular events,MACE)发生率的独立相关危险因素.方法 纳入心肌梗死后HFpEF患者共486例,患者MACE定义为全因死亡、HF症状再住院、再发非致死性心肌梗死、卒中.采用多因素Cox回归分析,筛选出与心肌梗死后HFpEF患者MACE相关的独立危险因素.结果 随访(29.43± 16.69)个月后,共有128例患者发生MACE事件.单因素Cox回归分析显示,年龄(HR=1.075,95%CI 1.058~1.093)、女性(HR=1.603,95%CI 1.090~2.358)、心率(HR=1.030,95%CI 1.022~1.038)、白细胞总数(HR=1.056,95%CI1.039~1.073)、高血压史(HR=1.556,95%CI 1.100~2.202)及糖尿病史(HR=1.820,95%CI 1.197~2.768)、NT-proBNP(HR=4.138,95%CI 2.231~7.675)、eGFR(HR=1.005,95%CI 1.004~ 1.007)与心肌梗死后HFpEF患者MACE事件相关,差异均有统计学意义(P<0.05),多因素Cox回归分析结果显示,年龄(HR=1.071,95%CI1.041~1.103)、心率(HR=1.022,95%CI 1.007~1.038)、NT-proBNP(HR=1.971,95%CI 1.035~3.755)和eGFR(HR=1.005,95%CI 1.001~1.011)与心肌梗死后HFpEF患者MACE事件独立相关(P<0.05).结论 年龄、心率、肾功能异常、NT-proBNP是心肌梗死后HFpEF患者预后不良的独立相关因素.Objective To investigate the independent predictors for long-term prognosis in AMI patients with HFpEF. Methods 486 AMI patients with HFpEF were enrolled in the study. Main demographic data, cardiovascular risk factors were obtained from medical records. Blood tests were conducted early in the morning in fasted patients. Echocardiography for left ventricle flinction through left ventricle ejection fraction ( LVEF) was performed by experienced physicians who were blinded to patients information. All-cause death, rehospitalization for HF, recurrent non-fatal myocardial infarction and stroke were defined as MACE. Results 128 (26.34%) experienced a MACE during a follow-up period o f (29.43± 16.69) months. Significant predictors o f a MACE were age(HR=1.075,95%CI 1.058~1.093), gender (HR=1.603,95%CI 1.090~2.358), heart rate(HR=1.030,95%CI 1.022~1.038), WBCs (HR= 1.056, 95%CI 1.039-1.073), hypertension (HR= 1.556, 95%CI 1.100-2.202), diabetes mellitus (HR=1.820, 95%CI 1.197-2.768), NT-proBNP (HR=4.138, 95%CI 2.231-7.675) and eGFR (H R =1.005, 95%CI 1.004-1.007) using univariate Cox analysis. Multivariate Cox analysis showed that age(HR= 1.071, 95%CI 1.041-1.103), heart rate (HR= 1.022, 95%CI 1.007-1.038), NT-proBNP (HR= 1.971, 95%CI 1.035-3.755) and eGFR (HR= 1.005, 95%CI 1.001-1.011) were significant and independent predictors of MACE. Conclusion The age, heart rate, renal dysfunction and NT-proBNP are independent factors associated with poor prognosis in patients with HFpEF after myocardial infarction.

关 键 词：急性心肌梗死 射血分数保留的心力衰竭 预后 

分 类 号：R542.22[医药卫生—心血管疾病]