老年扩张型心肌病患者发生左心室逆重构的预测因素分析  

Predictors of left ventricular reverse remodeling in elderly patients with dilated cardiomyopathy

作　　者：徐慧[1] 李志刚[1] 李小莉[1] 韩冰[1] 赵燕[1] Xu Hui;Li Zhigang;Li Xiaoli;Han Bing;Zhao Yan(Department of Cardiology,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院心内科,徐州221009

出　　处：《中华心力衰竭和心肌病杂志（中英文）》2023年第2期92-96,共5页Chinese Journal of Heart Failure and Cardiomyopathy

基　　金：江苏省科技厅重点研发项目(BE2015624)。

摘　　要：目的分析老年(年龄≥60岁)扩张型心肌病(DCM)患者经标准药物治疗后左心室逆重构(LVRR)的发生率及预测因素。方法回顾性纳入2018年8月至2019年4月因心力衰竭住院在徐州市中心医院诊断为DCM的老年患者,收集患者的一般临床资料和超声心动图数据,根据患者治疗后6个月后随访时的心功能改善情况和超声心动图结果进行分组,定义纽约心脏病学会(NYHA)心功能分级改善至I或Ⅱ级并且左心室射血分数(LVEF)增加>15%,或者LVEF绝对值≥50%,或者LVEF达到基线值2倍定义为LVRR组。计算LVRR的发生率,采用logistic回归分析法分析LVRR的基线预测因素。结果研究共纳入老年DCM患者93例,6个月随访时LVRR的发生率为12.9%(12/93),其LVEF由基线(31.17±9.09)%提高至随访时的(49.67±7.34)%(P<0.001),左心室舒张末期内径(LVEDD)由基线时的(66.50±7.59)mm缩小至随访时的(55.75±7.55)mm(P<0.001)。多因素logistic回归分析显示,服药依从性(比值比1.937,95%可信区间1.026~3.660,P=0.042)是老年DCM患者发生LVRR的独立预测因素。结论经过标准抗心衰药物治疗后,老年DCM患者的LVRR发生率为12.9%,治疗依从性是DCM患者发生LVRR的独立预测因素。Objective To investigate the incidence and predictors of left ventricular reverse remodeling(LVRR)in elderly patients with dilated cardiomyopathy(DCM)after standard drug therapy.Methods Elderly patients hospitalized due to heart failure in Xuzhou Central Hospital from August 2018 to April 2019 with the diagnosis of DCM were retrospectively enrolled.The general clinical data and echocardiographic data of the patients were collected.According to the improvement of cardiac function and echocardiographic results during the follow-up at 6 months after treatment,patients were divided into LVRR group which was defined as the improvement of NYHA function class to I or II and an absolute increase in LVEF>15%,or the absolute value of LVEF≥50%at follow-up,or the LVEF increased twice than the baseline value.The incidence of LVRR was calculated,and the baseline predictors of LVRR were identified by multivariate logistic regression analysis.Results A total of 93 elderly DCM patients were enrolled and the incidence of LVRR was 12.9%(12/93)at 6 months follow-up,of which the LVEF increased from(31.17±9.09)%at baseline to(49.67±7.34)%at follow-up(P<0.001),accompanied by a decrease in LVEDD from(66.50±7.59)mm at baseline to(55.75±7.55)mm at follow-up(P<0.001).Multivariate logistic regression analysis showed that medication compliance[odds ratio(OR)1.937,95%confidence interval(CI)1.026-3.660,P=0.042]was an independent predictor of LVRR in elderly DCM patients.Conclusion After standard anti-heart failure drug treatment,the incidence of LVRR in elderly patients with DCM is 12.9%,and treatment compliance is an independent predictor of LVRR in elderly DCM patients.

关 键 词：心肌病 扩张型 老年 左心室逆重构 预测因素 

分 类 号：R542.2[医药卫生—心血管疾病]