射血分数保留的心力衰竭患者心脏结构及功能的动态演变及其影响因素分析  

Dynamic Change of Cardiac Structure and Function Over Time in Heart Failure Patients With Preserved Ejection Fraction

作　　者：刘永铭[1] 杨京港[1] 薛丽丽[2] 杜颖石 邹全[2] 刘格婧 苟春丽 孙洁[1] 王晶[1] 陈金丽 刘艳英[1] 马苏美[2] LIU Yongming;YANG Jinggang;XUE Lili;DU Yingshi;ZOU Quan;LIU Gejing;GOU Chunli;SUN Jie;WANG Jing;CHEN Jinli;LIU Yanying;MA Sumei(Department of Geriatric Cardiology,The First Hospital of Lanzhou University,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》2023年第2期182-188,共7页Chinese Circulation Journal

基　　金：甘肃省重点研发计划(20YF8FA079)。

摘　　要：目的:分析射血分数保留的心力衰竭(HFpEF)患者心脏结构及功能的动态演变及其影响因素。方法:本研究为回顾性、纵向研究,纳入2010~2019年在兰州大学第一医院老年心血管科就诊的HFpEF患者306例,根据基线与末次随访数据,将患者分为左心室射血分数(LVEF)保持≥50%组(n=283)和LVEF转变为<50%组(n=23)。采用超声心动图评价心脏结构和功能的演变,探讨引起LVEF转变为<50%的危险因素,分析结构变化与功能变化、舒张功能变化与收缩功能变化的关系。结果:中位随访3.0(1.5,5.6)年期间,23例(7.5%)HFp EF患者的LVEF转变为<50%,其中7例(2.3%)LVEF<40%。Logistic回归分析显示,冠心病史(OR=2.218,95%CI:0.982~5.519,P=0.087)、较大的左心室舒张末期容积指数(OR=1.034,95%CI:1.010~1.059,P=0.005)、较大的左心室收缩末期容积(OR=1.036,95%CI:1.014~1.058,P<0.001)、较小的LVEF(OR=0.940,95%CI:0.087~1.058,P=0.077)是LVEF≥50%转变为LVEF<50%的独立危险因素。随访中组织多普勒二尖瓣环收缩期峰值速度(s’)和舒张早期峰值速度(e’)均进一步降低(幅度为-5.1%~-27.6%),二尖瓣血流频谱舒张早期峰值速度(E)/e’进一步升高(幅度为9.5%~46.3%),LVEF转变为<50%组的变化幅度大于LVEF保持≥50%组。线性相关分析显示,随访年限与二尖瓣环收缩速度降低值和舒张速度降低值(r值为-0.182和-0.254)、左心房内径与内径指数增大值(r值为0.140和0.173)、E/组织多普勒二尖瓣环室间隔部舒张早期峰值速度(e’S)升高值(r值为0.165)、肺动脉收缩压升高值(r值为0.212)均呈正相关(P均<0.05)。多元线性回归分析显示,左心房容积指数增长值与E/e’增长值(β=0.304,P<0.01)、肺动脉收缩压增长值与左心房容积指数增长值(β=0.173,P<0.01)、N末端B型利钠肽原增长值与左心房容积指数增长值、二尖瓣环收缩速度降低值均独立相关(β=0.215、-0.164,P均<0.05)。相关分析显示,同侧室壁组织多普勒收缩早Objectives:To investigate the dynamic change of cardiac structure and function in heart failure patients with preserved ejection fraction(HFpEF)over time,and to explore the related risk factors.Methods:A total of 306 HFpEF patients were enrolled in this longitudinal retrospective study.According to the last follow-up results,patients were divided into group with left ventricular ejection fraction(LVEF)≥50%(n=283)and group with LVEF<50%(n=23).Comprehensive echocardiography and tissue Doppler measurements were employed for the serial evaluation of cardiac structure and function.The risk factors that cause LVEF to change to<50%were explored and the relationships between structural and functional changes as well as systolic with diastolic functional changes were analyzed.Results:During a median of 3 years follow-up,LVEF<50%was identified in 23 patients(7.5%),of which 7 patients(2.3%)had LVEF<40%.Logistic regression analysis revealed that history of coronary artery diseases(OR=2.218,95%CI:0.982-5.519,P=0.087),higher left ventricular end-diastolic volume index(LVEDVI)(OR=1.034,95%CI:1.010-1.059,P=0.005),higher left ventricular end-systolic volume(LVESV)(OR=1.036,95%CI:1.014-1.058,P<0.001),lower LVEF(OR=0.940,95%CI:0.087-1.058,P=0.077)were independent predictors for the phenotype transition to LVEF<50%.Tissue Doppler mitral annular systolic velocity(s’)and early diastolic velocity(e’)decreased(from-5.1%to-27.6%)and the ratio of peak early mitral filling velocity(E)to e’(E/e’)increased(from 9.5%to 46.3%)further during follow-up.Follow-up intervals were correlated with decreased values of s’and e’(r=-0.182 to-0.254,all P<0.05),increased left atrial diameter and diameter index(r=0.140,0.173,all P<0.05),E/e’S(r=0.165,P<0.05),and pulmonary arterial systolic pressure(PASP)(r=0.212,P<0.05).Multiple linear regression analysis showed that there were significant correlations among values of declined s’,elevated left atrial volume index(LAVI)and PASP,and increased N-terminal pro B-type natriuretic peptide(NT-proB

关 键 词：射血分数保留的心力衰竭 心脏结构 心脏功能 纵向研究 

分 类 号：R541.4[医药卫生—心血管疾病]