左室舒张末期内径对慢性心力衰竭患者远期预后的预测价值  

Predictive value of left ventricular end-diastolic inner diameter to long-term prognosis in patients with chronic heart failure

作　　者：李雨濛 吴华芹[2] 张并璇[1] 徐霞 王亚娇 宋庆桥[1] Li Yumeng;Wu Huaqin;Zhang Bingxuan;Xu Xia;Wang Yajiao;Song Qingqiao(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;不详)

机构地区：[1]中国中医科学院广安门医院综合科,北京100053 [2]中国中医科学院广安门医院心血管科,北京100053

出　　处：《中国循证心血管医学杂志》2022年第11期1341-1344,1348,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家自然科学基金青年项目(82004348);首都卫生发展专项项目(2020-2-4153)。

摘　　要：目的探讨超声心动图参数在慢性心力衰竭(CHF)患者远期生存中的预测价值。方法入选2006年1月至2014年8月于中国中医科学院广安门医院心内科收治的CHF患者,随访周期730d,终点事件为全因死亡。根据是否发生终点事件其分为非终点事件组和终点事件组,比较两组超声心动指标的差异,采用受试者工作曲线(ROC)判断左室舒张末期内径(LVEDD)对CHF全因死亡的预测能力,以Kaplan-Meier生存曲线分析生存率,并采用Cox回归模型分析超声心动图指标与远期预后的相关性。结果共纳入CHF患者546例,发生终点事件者169例(31.0%)。ROC曲线显示,LVEDD预测CHF患者远期预后的曲线下面积为0.572;Kaplan-Meier曲线分析显示,LVEDD≥54.5mm时CHF患者2年生存率明显降低(Log-rank检验:χ^(2)=5.794,P=0.016)。单因素Cox回归显示,LVEDD、左室射血分数(LVEF)、右房内径(RA)、二尖瓣反流和三尖瓣反流是CHF患者全因死亡的影响因素。多变量校正后,LVEDD是CHF患者全因死亡的独立预测因素(HR=1.020,95%CI:1.000~1.039,P=0.048)。结论超声心动图指标对CHF患者远期预后具有预测价值,其中LVEDD是CHF全因死亡的独立危险因素。Objective To investigate the predictive value of echocardiogram indexes to long-term survival in patients with chronic heart failure(CHF).Methods CHF patients were chosen from Department of Cardiology in Guang`anmen Hospital affiliated to China Academy of Chinese Medical Sciences from Jan.2006 to Aug.2014.The follow-up period was 730d and end-point event was all-cause death.According to the occurrence of endpoint event,all patients were divided into non-end-point event group and end-point event group.The differences in echocardiography indexes were compared between 2 groups.The predictive power of left ventricular end-diastolic inner diameter(LVEDD)for all-cause death of CHF was determined by using receiver operating curve(ROC).The survival rate was analyzed by using Kaplan-Meier survival curve.The correlation between echocardiogram indexes and long-term prognosis was analyzed by using Cox regression model.Results There were totally 546 CHF patients included,and end-point event occurred in 169 patients(31.0%).The results of ROC analysis showed that the area under curve(AUC)of LVEDD was 0.572 in predicting long-term prognosis in CHF patients.The results of Kaplan-Meier curve analysis showed that when LVEDD≥54.5mm,the 2y survival rate decreased significantly in CHF patients(Log-rank:χ^(2)=5.794,P=0.016).The results of Cox regression analysis showed that LVEDD,left ventricular ejection fraction(LVEF),right atrial diameter(RA),mitral regurgitation and tricuspid regurgitation were influence factors of all-cause death in CHF patients.After multivariable correction,LVEDD was an independent predictor of all-cause death in CHF patients(HR=1.020,95%CI:1.000~1.039,P=0.048).Conclusion Echocardiogram indexes have predictive value to long-term prognosis,and LVEDD is an independent predictor of all-cause death in CHF patients.

关 键 词：慢性心力衰竭 超声心动图 远期预后 左室舒张末期内径 

分 类 号：R541.61[医药卫生—心血管疾病]