TAPSE/PASP评估老年射血分数保留心力衰竭患者的预后  

TAPSE/PASP evaluates the prognosis of elderly patients with heart failure with preserved ejection fraction

作　　者：石亚楠 原芳 徐予 SHI Ya'nan;YUAN Fang;XU Yu(Department of Heart Failure Disease,Fuwai Central China Cardiovascular Hospital,Henan Provincial People's Hospital,Zhengzhou,450003,China)

机构地区：[1]阜外华中心血管病医院河南省人民医院心力衰竭病区,郑州450003

出　　处：《临床心血管病杂志》2024年第2期134-141,共8页Journal of Clinical Cardiology

摘　　要：目的:三尖瓣环收缩期位移(tricuspid annular plane systolic excursion,TAPSE)与肺动脉收缩压(pulmonary artery systolic pressure,PASP)的比值是评估右心室-肺动脉耦联的重要指标。本研究评估TAPSE/PASP对老年射血分数保留心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者的预后价值。方法:回顾性分析2017年12月—2021年7月于阜外华中心血管病医院住院的年龄>65岁HFpEF患者466例,以全因死亡和心力衰竭再住院作为复合终点,2022年11月—2022年12月完成随访。Cox比例风险回归模型分析终点事件的危险因素,受试者工作特征曲线(ROC)分析TAPSE、PASP及TAPSE/PASP对复合终点的预测价值。采用Kaplan-Meier生存曲线比较组间的累积生存率。结果:多因素Cox回归模型显示,TAPSE/PASP≤0.35mm/mmHg、低钠血症、血糖、缺血性心肌病为老年HFpEF患者发生复合终点事件的独立预测因子。ROC曲线显示,TAPSE/PASP、TAPSE及PASP对老年HFpEF患者发生全因死亡和心力衰竭再住院的预测AUC分别为0.843(95%CI 0.807~0.879,P<0.001)、0.810(95%CI 0.770~0.849,P<0.001)、0.716(95%CI 0.669~0.764,P<0.001)。Kaplan-Meier生存曲线显示,TAPSE/PASP≤0.35mm/mmHg组患者的累积生存率显著低于TAPSE/PASP>0.35mm/mmHg组(P<0.001)。结论:TAPSE/PASP是老年HFpEF患者全因死亡和心力衰竭再住院的独立预测因子。TAPSE/PASP>0.35mm/mmHg时生存率较高。Objective:The ratio of tricuspid annular systolic plane excursion(TAPSE)to pulmonary artery systolic pressure(PASP)is an important index for evaluating right ventricle-pulmonary artery coupling.The aim of this study was to evaluate the prognostic value of TAPSE/PASP in elderly patients with heart failure with preserved ejection fraction(HFpEF).Methods:A total of 466HFpEF patients aged>65years who were hospitalized Fuwai Huazhong Cardiovascular Hospital from December 2017to July 2021were retrospectively analyzed.Allcause death and rehospitalization for heart failure were used as the composite endpoint.Follow-up was completed from November 2022to December 2022.Kaplan-Meier survival analysis curves were used to compare cumulative survival between groups.Cox proportional hazards regression models were used to analyze risk factors for endpoint events;and receiver operating characteristic curves(ROC)were used to analyze the predictive value of TAPSE/PASP,TAPSE,and PASP for composite endpoint events.Results:Multivariate Cox regression models showed that TAPSE/PASP≤0.35mm/mmHg,hyponatremia,blood glucose,and ischemic cardiomyopathy were independent predictors of composite endpoint events in elderly HFPEF patients.ROC curves showed that TAPSE/PASP was superior to TAPSE and PASP alone in predicting all-cause mortality and rehospitalization for heart failure in elderly patients with HFpEF,with AUCs of 0.843(95%CI:0.807-0.879,P<0.001),0.810(95%CI:0.770-0.849,P<0.001),and 0.716(95%CI:0.669-0.764,P<0.001),respectively.Kaplan-Meier survival analysis curves showed that the cumulative survival rate of patients in the TAPSE/PASP≤0.35 mm/mmHg group was significantly lower than that in the TAPSE/PASP>0.35mm/mmHg group(P<0.001).Conclusion:TAPSE/PASP is an independent predictor of all-cause death and heart failure rehospitalization in elderly HFpEF patients.The survival rate was higher when TAPSE/PASP>0.35mm/mmHg.

关 键 词：右心室-肺动脉耦联 三尖瓣环收缩期位移 肺动脉收缩压 射血分数保留型心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]