左心房存储应变对老年心力衰竭病人远期不良预后的预测价值  

Predictive value of left atrial strain for long-term poor prognosis of elderly patients with heart failure

作　　者：马晓英[1] 李久民 钦佩[1] 刘淼 金明磊[1] MA Xiao-ying;QIN Pei;LIU Miao;JIN Ming-lei;LI Jiu-min(Department of Geriatrics,Chengde Central Hospital,Chengde 067000,China;Department of Cardiology,Chengde County Hospital of Traditional Chinese Medicine,Chengde 067400,Chin)

机构地区：[1]承德市中心医院老年病科,河北省承德市067000 [2]承德县中医院心内科,河北省承德市067000

出　　处：《实用老年医学》2022年第10期1033-1037,共5页Practical Geriatrics

基　　金：承德市科技计划项目(202002A014)。

摘　　要：目的探讨左心房存储应变对老年心力衰竭(心衰)病人远期不良预后的预测价值。方法前瞻性选取2018年7月至2019年7月承德市中心医院收治的136例年龄≥65岁老年心衰病人为研究对象,随访观察2年,以全因死亡作为不良预后,并以此分为预后不良组和预后良好组,采用多因素Cox回归分析老年心衰病人远期不良预后的影响因素。结果截至随访终点,失访11例,最终125例获得随访,其中42例(33.60%)出现全因死亡(预后不良);83例(66.40%)预后良好。预后不良组与预后良好组左心房容积指数(LAVI)、左心房储备期应变(LARS)、LVEF及N末端B型利钠肽原(NT-proBNP)水平比较,差异具有统计学意义(P<0.01)。多因素Cox回归分析显示,NT-proBNP(HR=1.001,95%CI:1.000~1.002)、LAVI(HR=1.082,95%CI:1.002~1.168)为老年心衰病人远期不良预后的独立危险因素,LVEF(HR=0.944,95%CI:0.893~0.998)、LARS(HR=0.945,95%CI:0.902~0.991)为老年心衰病人远期不良预后的保护因素。ROC曲线分析显示,LARS(AUC=0.847,95%CI:0.772~0.905)对远期不良预后的预测价值高于LVEF(AUC=0.670,95%CI:0.650~0.811)和LAVI(AUC=0.698,95%CI:0.721~0.868)。结论LAVI、LARS、LVEF及NT-proBNP可预测老年心衰病人远期不良预后,LARS是优于LAVI、LVEF的左心房参数。Objective To explore the predictive value of left atrial strain for the long-term poor prognosis of elderly patients with heart failure.Methods A total of 136 elderly patients with heart failure age≥65 years old admitted to Chengde Central Hospital from July 2018 to July 2019 were prospectively selected as the research subjects.The patients were followed up for 2 years.According to the all-cause death results,they were divided into poor prognosis group and good prognosis group.The influencing factors of long-term poor prognosis of the elderly patients with heart failure were analyzed by multivariate Cox regression.Results By the end of the follow-up,42 cases(33.60%)presented with all-cause death and 83 cases(66.40%)with a good prognosis.There were significant differences in the levels of left atrial volume index(LAVI),left atrial reserve strain(LARS),left ventricular ejection fraction(LVEF)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)between poor prognosis group and good prognosis group.Multivariate Cox regression analysis showed that NT-proBNP(HR=1.001,95%CI:1.000-1.002)and LAVI(HR=1.082,95%CI:1.002-1.168)were the independent risk factors of long-term poor prognosis,and LVEF(HR=0.944,95%CI:0.893-0.998)and LARS(HR=0.945,95%CI:0.902-0.991)were the protective factors of long-term poor prognosis in the elderly patients with heart failure(all P<0.05).ROC curve analysis showed that the area under curve(AUC)of LARS was higher than that of LVEF and LAVI.Conclusions LAVI,LARS,LVEF and NT-proBNP can predict the long-term poor prognosis of elderly patients with heart failure,and LARS is more valuable than other parameters.

关 键 词：左心房存储应变 心力衰竭 老年人 预后 

分 类 号：R541.61[医药卫生—心血管疾病]