射血分数保留或减低心力衰竭患者肺动脉压及右心结构变化的研究  

Pulmonary Arterial Pressure and Right Heart Structural Changes in Heart Failure Patients With Preserved or Reduced Ejection Fraction

作　　者：苟春丽 刘永铭[1] 薛丽丽[2] 马苏美[2] 杨京港[1] 杨琳[1] 杜颖石 GOU Chunli;LIU Yongming;XUE Lili;MA Sumei;YANG Jinggang;YANG Lin;DU Yingshi(Department of Geriatric Cardiology,The First Hospital of Lanzhou University,Gansu Provincial Clinical Research Center for Geriatric Medicine,Lanzhou(730000),Gansu,China)

机构地区：[1]兰州大学第一医院老年心血管科甘肃省老年疾病临床医学研究中心,甘肃省兰州市730000 [2]兰州大学第一医院超声诊断科,甘肃省兰州市730000

出　　处：《中国循环杂志》2020年第11期1108-1114,共7页Chinese Circulation Journal

基　　金：国家临床重点专科建设项目[国卫医办函(2013)240号]。

摘　　要：目的:探讨射血分数保留心力衰竭(HFpEF)与射血分数减低心力衰竭(HFrEF)两类患者肺动脉压及右心结构的变化特点并分析其影响因素。方法:连续入选2013年9月至2018年12月兰州大学第一医院老年心血管科收住的新诊断心力衰竭患者619例,依据2008年欧洲心脏病学会心力衰竭诊断标准,将患者分为HFpEF组(n=461)和HFrEF组(n=158),并观察临床特征及右心结构改变。另选同期年龄、性别相匹配的正常健康人196例作为正常对照组,以确定右心结构指标参考范围。为观察肺动脉高压与右心结构的关系,将两组患者分别进一步分为肺动脉高压与非肺动脉高压两个亚组。结果:(1)HFrEF组肺动脉高压患病率高于HFpEF组(77.2%vs.61.0%,P=0.001);HFpEF组不同右心结构参数异常率为5.7%~46.5%,HFrEF组为10.9%~51.5%,两组右心结构异常发生率由高到低依次为右心房扩大、右心室扩大和右心室游离壁增厚。(2)HFrEF组右心室基底部内径(RV-D1)及基底部至心尖部长度(RV-D3)、主动脉瓣上及肺动脉瓣水平右心室流出道内径以及右心房短径扩大比率及平均值均大于HFpEF组(P均<0.05)。(3)HFrEF组合并肺动脉高压者RV-D1、右心室中部内径、右心房短径、右心房长径和右心房面积大于不合并肺动脉高压者(P均<0.05),而HFpEF合并肺动脉高压者仅右心房短径、右心房长径、右心房面积大于不合并肺动脉高压者(P均<0.05)。(4)多元线性回归分析显示,无论HFrEF还是HFpEF,右心房长径、右心房短径及右心房面积与肺动脉收缩压独立相关(HFrEF组β值分别为0.227、0.204、0.247,P均<0.05;HFpEF组β值分别为0.225、0.143、0.178,P均<0.05),右心室游离壁厚度与肺动脉收缩压不相关。结论:HFpEF及HFrEF右心结构异常发生率由高到低依次为右心房扩大、右心室扩大和右心室游离壁增厚。HFrEF较HFpEF右心室扩大更为常见和严重,但HFpEF与HFrEF右心房扩大程度相似。心力衰�Objectives:To investigate the changes of pulmonary arterial pressure and right heart structure in heart failure patients with preserved ejection fraction(HFpEF)as well as reduced ejection fraction(HFrEF)and to analyze related influential factors.Methods:A total of 619 newly-diagnosed heart failure patients were enrolled and divided into HFpEF group(n=461)and HFrEF group(n=158),according to the 2008 ESC diagnostic criteria for heart failure.Pulmonary pressure and right heart structure in these patients were evaluated.196 age-and sex-matched healthy volunteers served as control group and the reference range of right heart structure parameters were derived from these healthy volunteers.The HFpEF and HFrEF patients were further divided into two subgroups:with or without pulmonary hypertension groups to observe the relationship between pulmonary hypertension and right heart structure in heart failure patients.Results:(1)The prevalence of pulmonary hypertension was significantly higher in HFrEF group than in HFpEF group(77.2%vs.61.0%,P=0.001),the abnormal rates of different structural parameters of right heart ranged from 5.7%-46.5%in HFpEF and 10.9%-51.5%in HFrEF,leading by the highest rate of right atrial enlargement,followed by right ventricular enlargement,and right ventricular free wall thickening.(2)Compared with HFpEF group,the abnormal rates and average values of the RV basal and longitudinal dimension(RV-D1,RV-D3),right ventricular outflow tract(RVOT1,RVOT2)and right atrial minor dimension were significantly higher in HFrEF group(all P<0.05).RV-D1 and mid right ventricular diameters,right atrial minor dimension,right atrial major dimension and right atrial area were higher in HFrEF with pulmonary hypertension group than in HFrEF without pulmonary hypertension group(all P<0.05),while right atrial minor dimension,right atrial major dimension and right atrial area values were higher in HFpEF with pulmonary hypertension group than HFpEF without pulmonary hypertension group(all P<0.05).(3)Multivariate linear regres

关 键 词：射血分数保留心力衰竭 射血分数减低心力衰竭 右心结构 肺动脉压 

分 类 号：R541[医药卫生—心血管疾病]