老年射血分数降低心力衰竭患者住院期间恶性室性心律失常的发生情况及其对预后的影响  

Incidence of malignant ventricular arrhythmias during hospitalization in elderly heart failure patients with reduced ejection fraction and its impact on the prognosis

作　　者：郝修宏[1] 王磊[1] 高辉[1] 白智峰[1] Hao Xiuhong;Wang Lei;Gao Hui;Bai Zhifeng(Department of Cardiology,the First People's Hospital of Shangqiu,Shangqiu 476100,China)

机构地区：[1]商丘市第一人民医院心血管内科,商丘476100

出　　处：《中华老年医学杂志》2024年第6期697-703,共7页Chinese Journal of Geriatrics

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210988)。

摘　　要：目的:分析老年射血分数降低心力衰竭(心衰)(HFrEF)患者住院期间的恶性室性心律失常(VA)发生情况及其对预后的影响。方法:纳入2017年1月至2020年6月商丘市第一人民医院共收治的1171例老年心衰患者,根据住院期间是否新发VA(包括持续性室速、室颤或室扑)分组,按照倾向性评分匹配法、以1∶4∶4比例分为VA组(85例)、左心室射血分数(LVEF)降低对照组(340例)和LVEF正常对照组(340例),分析住院期间的基线临床资料,主要观察指标为3组随访2年的主要不良心血管事件(MACE)。结果:倾向性评分匹配后,LVEF正常对照组的N末端脑利钠肽前体(NT-proBNP)、左心室舒张末期直径(LVEDD)和左心室收缩末期直径(LVESD)低于LVEF降低对照组和VA组,LVEF显著高于LVEF降低对照组和VA组(均P<0.05)。中位随访22(17~25)个月结果显示,发生MACE共219例(28.6%),包括30例心源性死亡、133例心衰加重再入院和56例急性冠状动脉综合征。Kaplan-Meier生存分析结果显示,VA组的总体MACE发生风险高于LVEF正常对照组和LVEF降低对照组(χ2=6.213、P=0.012);3组患者中,VA组的心源性死亡和心衰加重再入院风险最高,均显著高于LVEF正常对照组和LVEF降低对照组(χ2=4.143、16.861,均P<0.05)。多因素Logistic回归分析结果显示,既往VA史(OR=1.317、95%CI:1.109~1.564、P=0.002)、NT-proBNP(OR=2.138、95%CI:1.235~3.701、P=0.007)和LVEDD(OR=2.413、95%CI:1.134~5.135、P=0.022)与住院期间发生VA风险增加相关。多因素Cox回归分析结果显示,年龄>68岁(HR=1.723、95%CI:1.134~2.618、P=0.011)、新发VA(HR=2.346、95%CI:1.268~4.341、P=0.007)、糖尿病(HR=2.008、95%CI:1.135~3.553、P=0.017)、NT-proBNP>1957.3 ng/L(HR=2.734、95%CI:1.368~5.464、P=0.004)、LVEF<35.0%(HR=2.265、95%CI:1.206~4.254、P=0.011)、入院后接受植入式心脏复律除颤器(HR=0.887、95%CI:0.789~0.997、P=0.045)和钠-葡萄糖共转运蛋白2(SGLT2)抑制剂(HR=0.904、95%CI:0.833~0.981、P=0.016)与随访Objective To analyze the occurrence of malignant ventricular arrhythmias(VA)in elderly heart failure patients with reduced ejection fraction(HFrEF)and its influence on the prognosis.Methods A total of 1171 elderly patients with heart failure were included in this study.These patients were admitted to the First People's Hospital of Shangqiu from January 2017 to June 2020.They were divided into three groups:VA group(85 cases),HFrEF group(340 cases),and heart failure with normal left ventricular ejection fracture(LVEF)group(340 cases).The division was based on the propensity score matching(PSM)method with a 1∶4∶4 ratio.The main outcome measure was major adverse cardiovascular events(MACE)in the three groups,which were followed up for 2 years.Results After PSM,the N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular end diastolic diameter(LVEDD),and left ventricular end systolic diameter(LVESD)of the LVEF normal group were significantly lower than those of the HFrEF group and VA group,while LVEF was significantly higher(P<0.05 for all).During a median follow-up of 22(17-25)months,a total of 219 cases(28.6%)of MACE occurred,including 30 cardiac deaths,133 readmissions with worsening heart failure,and 56 cases of acute coronary syndrome.Kaplan-Meier survival analysis revealed that the VA group had a significantly higher overall risk of MACE compared to the normal LVEF control group and LVEF reduced control group(χ2=6.213,P=0.012).Among the three groups,the VA group exhibited the highest risk of cardiogenic death and worsening heart failure readmission,surpassing the normal LVEF group and HFrEF group(χ2=4.143,16.861,both P<0.05).The results of the multivariate Logistic regression analysis revealed that a history of VA(OR=1.317,95%CI:1.109-1.564,P=0.002),NT-proBNP(OR=2.138,95%CI:1.235-3.701,P=0.007),and LVEDD(OR=2.413,95%CI:1.134-5.135,P=0.022)were found to be associated with an increased risk of VA during hospitalization.Additionally,the multivariate Cox regression analysis indicated that age>68 ye

关 键 词：心力衰竭 心律失常 心性 不良心血管事件 相关因素 

分 类 号：R541.6[医药卫生—心血管疾病]