射血分数保留的心力衰竭患者右心功能障碍特征及影响因素分析  

Analysis of the Features and Risk Factors of Right Ventricular Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction

作　　者：苟春丽 刘永铭[1] 薛丽丽[2] 马苏美[2] 杨京港[1] 邹全[2] 杜颖石 刘格婧 王晶[1] GOU Chunli;LIU Yongming;XUE Lili;MA Sumei;YANG Jinggang;ZOU Quan;DU Yingshi;LIU Gejing;WANG Jing(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》2022年第5期494-499,共6页Chinese Circulation Journal

基　　金：甘肃省科技厅重点研发计划(20YF8FA079)。

摘　　要：目的:探讨射血分数保留的心力衰竭(HFpEF)患者右心功能变化特点,分析影响右心功能的危险因素。方法:连续入选2019年1月至2020年12月新诊断HFpEF患者203例,采用超声心动图测定右心功能,根据患者有或无右心功能障碍(收缩功能参数至少两项异常),分为右心功能障碍组(n=105)与右心功能正常组(n=98)进行对比分析。观察患者右心室收缩及舒张功能的变化特点,分析右心室功能与肺动脉压、肺血管阻力(PVR)、左心功能的关系,并探讨病史、疾病严重程度以及合并症对右心功能的影响。结果:203例HFpEF患者右心室收缩功能指标异常率为18.2%~57.7%,其中三尖瓣环平面收缩期位移(TAPSE)异常率最高(57.7%),三尖瓣环侧壁收缩期速度峰值(s’)异常率最低(18.2%);舒张功能指标异常率为23.6%~32.5%;肺动脉高压患病率为72.4%。51.7%的患者存在右心室收缩功能障碍(即右心功能障碍组),至少两项舒张功能参数异常的比例为29.0%。与右心功能正常组相比,右心功能障碍组TAPSE、s’均较低,而肺动脉收缩压(PASP)、PVR、左心房容积指数(LAVi)均较高,差异均有统计学意义(P均<0.05);右心功能障碍组NYHA心功能分级Ⅲ~Ⅳ级比例更高,两组间舒张功能指标差异无统计学意义。Logistic回归分析显示,心房颤动、慢性阻塞性肺疾病(COPD)为右心功能障碍的独立危险因素。简单线性相关及多元线性回归分析显示,TAPSE与PVR、PASP、LAVi呈负相关(r分别为-0.316、-0.218、-0.181,P均<0.05),与左心室射血分数呈正相关(r=0.258,P<0.01);LAVi、PVR是TAPSE、s’的独立预测因素。结论:HFpEF患者右心室收缩和舒张功能均有不同程度损害,以收缩功能障碍为主。肺动脉高压、心房颤动、COPD是HFpEF患者右心功能损害的重要危险因素,PVR升高与右心损害的相关性强于肺动脉高压。Objectives:To investigate the features and explore the risk factors of right heart dysfunction in patients with heart failure with preserved ejection fraction(HFpEF).Methods:Two hundred and tree consecutive newly-diagnosed HFpEF patients were recruited from January 2019 to December 2020.Comprehensive systolic and diastolic cardiac function of right ventricle was evaluated by echocardiography to reveal the features of right heart dysfunction.The relationship between right heart dysfunction and pulmonary artery pressure,pulmonary vascular resistance,and left ventricular function was analyzed.Furthermore,the impact of the history,comorbidity,and NYHA classification on right heart dysfunction was also investigated.Results:The abnormality rates of right ventricular systolic parameters ranged from 18.2%-57.7%,of which the abnormality rate of tricuspid annular plane systolic excursion(TAPSE)was the highest and that of tricuspid annular peak systolic velocity(s’)was the lowest.The abnormality rates of right ventricular diastolic parameters ranged from 23.6%-32.5%.The prevalence of pulmonary hypertension was 72.4%.The patients with at least two abnormal right cardiac systolic parameters(right ventricular dysfunction group,n=105)and the patients with at least two abnormal right cardiac diastolic parameters accounted for 51.7%and 29.0%respectively in this patient cohort.Compared with non-right ventricular dysfunction group(n=98)TAPSE and s’values were significantly lower,while pulmonary artery systolic pressure(PASP),pulmonary vascular resistance(PVR),left atrial volume index(LAVi)and the proportion of NYHAⅢ-IV were significantly higher in right ventricular dysfunction group(all P<0.05).Right ventricular diastolic parameters were similar between the two groups.Binary logistic regression analysis showed that atrial fibrillation and COPD were the independent predictors of right heart dysfunction.Bivariate linear correlation and multiple linear regression analysis showed that TAPSE was negatively correlated with PVR,PASP

关 键 词：射血分数保留的心力衰竭 右心功能障碍 肺动脉高压 肺血管阻力 

分 类 号：R54[医药卫生—心血管疾病]