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2024-5-25
Vol 32, issue 5

ISSUE

2023 年3 期 第31 卷

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缺血性心肌病合并射血分数改善的心力衰竭患者的临床特征及预后研究

ClinicalCharacteristicsandPrognosisofPatientswithIschemicCardiomyopathyCombinedwithHeartFailurewithImprovedEjectionFraction

作者:李少杰,梁浩,苏康康,谷剑,陈淑霞

单位:
1.河北北方学院研究生院2.河北省人民医院心血管内科
Units:
1.GraduateSchoolofHebeiNorthUniversity,Zhangjiakou075000,China2.DepartmentofHeartCenter,HebeiGeneralHospital,Shijiazhuang050051,China
关键词:
心力衰竭; 左心室射血分数; 射血分数改善; 缺血性心肌病; 预后; 影响因素;
Keywords:
Heartfailure;Leftventricularejectionfraction;Improvedejectionfraction;Ischemiccardiomyopathy;Prognosis;Influencingfactors
CLC:
R541.62
DOI:
10.12114/j.issn.1008-5971.2023.00.033
Funds:
河北省重点研发计划项目( 22377783D?); 2022年度河北省医学科学研究课题计划( 20220821?)

摘要:

目的 探讨缺血性心肌病(ICM)合并射血分数改善的心力衰竭(HFimpEF)患者的临床特征及预后。方法 选取2018年6月至2021年5月河北省人民医院心脏中心收治的ICM合并慢性心力衰竭(HF)患者425例。根据基线、复查左心室射血分数(LVEF)将其分为HFimpEF组(基线LVEF≤40%,复查LVEF>40%,n=95)、射血分数中间值的心力衰竭(HFmrEF)组(复查LVEF为41%~49%,n=84)、射血分数降低的心力衰竭(HFrEF)组(基线LVEF≤49%,复查LVEF≤40%,n=178)、射血分数保留的心力衰竭(HFpEF)组(基线LVEF及复查LVEF均≥50%,n=68)。比较四组一般资料、超声心动图检查指标、实验室检查指标、治疗情况、全因死亡率、全因再入院率。采用单因素、多因素Cox比例风险回归分析探讨ICM合并HFimpHF患者全因死亡、全因再入院的影响因素。结果 HFimpEF组年龄小于HFpEF组,收缩压(SBP)低于HFpEF组,舒张压(DBP)低于HFrEF组(P<0.05);HFimpEF组基线左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)小于HFrEF组,大于HFpEF组(P<0.05);HFimpEF组血红蛋白、红细胞计数高于HFpEF组,血小板计数高于HFrEF组,N末端脑钠肽前体(NTproBNP)低于HFrEF组(P<0.05);HFimpEF组使用血管紧张素受体脑啡肽酶抑制剂(ARNI)、醛固酮受体拮抗剂(MRA)、利尿剂、抗血小板药、重组人脑利钠肽者占比高于HFpEF组,使用钙通道阻滞剂(CCB)者占比低于HFpEF组(P<0.05);HFimpEF组全因死亡率低于HFrEF组(P<0.05);HFimpEF组全因再入院率低于HFmrEF组(P<0.05)。多因素Cox比例风险回归分析结果显示,合并心房颤动(AF)、贫血是ICM合并HFimpEF患者全因死亡的危险因素,BMI升高、基线LVEDD>55 mm是ICM合并HFimpEF患者全因再入院的危险因素,使用钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)是ICM合并HFimpEF患者全因再入院的保护因素(P<0.05)。结论 在ICM患者中,合并HFimpEF者年龄较小、血压较低、心室重构程度较轻、使用ARNI及MRA等药物的比例较高、全因死亡率和全因再入院率较低,而合并AF、贫血是ICM合并HFimpEF患者全因死亡的独立危险因素,BMI升高、基线LVEDD>55 mm是ICM合并HFimpEF患者全因再入院的独立危险因素,使用SGLT2i是ICM合并HFimpEF患者全因再入院的独立保护因素。

Abstract:

ObjectiveToinvestigatetheclinicalcharacteristicsandprognosisofpatientswithischemiccardiomyopathy(ICM)combinedwithheartfailurewithimprovedejectionfraction(HFimpEF).MethodsAtotalof425patientswithICMcomplicatedwithchronicheartfailure(HF)admittedtotheHeartCenterofHebeiGeneralHospitalfromJune2018toMay2021wereselected.Accordingtobaselineandreviewleftventricularejectionfraction(LVEF),thepatientsweredividedintoHFimpEFgroup(baselineLVEF≤ 40%,reviewLVEF>40%,n=95),heartfailurewithmid-rangeejectionfraction(HFmrEF)group(reviewLVEFwas41%-49%,n=84),heartfailurewithreducedejectionfraction(HFrEF)group(baselineLVEF≤ 49%,reviewLVEF≤ 40%,n=178),heartfailurewithpreservedejectionfraction(HFpEF)group(baselineLVEFandreviewLVEFwereboth≥50%,n=68).Thegeneraldata,echocardiogramindexes,laboratoryexaminationindexes,treatmentstatus,all-cauesmortalityandall-causereadmmisonratewerecomparedamongthefourgroups.UnivariateandmultivariateCoxproportionalriskregressionanalysiswasusedtoinvestigatetheinfluencingfactorsofall-causedeathandall-causereadmissioninICMpatients combinedwithHFimpEF.ResultsTheageofHFimpEFgroupwasyoungerthanthatofHFpEFgroup,andsystolicbloodpressure(SBP)waslowerthanthatofHFpEFgroup,diastolicbloodpressure(DBP)waslowerthanthatofHFrEFgroup(P<0.05).Baselineleftventricularendsystolicdiameter(LVESD)andleftventricularenddiastolicdiameter(LVEDD)inHFimpEFgroupwerelowerthanthoseinHFrEFgroup,buthigherthanthoseinHFpEFgroup(P<0.05).ThehemoglobinandredbloodcellcountofHFimpEFgroupwerehigherthanthoseofHFpEFgroup,plateletcountwashigherthanthatofHFrEFgroup,andtheN-terminalpro-brainnatriureticpeptide(NT-proBNP)waslowerthanthatofHFrEFgroup(P<0.05).Theproportionofpatientsusingangiotensinreceptorneprilysininhibitor(ARNI),mineralcorticoidreceptantagonist(MRA),diuretics,antiplateletdrugsandrecombinanthumannatriureticpeptideinHFimpEFgroupwashigherthanthatinHFpEFgroup,andtheproportionofpatientsusingcalciumchannelblocker(CCB)waslowerthanthatinHFpEFgroup(P<0.05).Theall-causemortalityofHFimpEFgroupwaslowerthanthatofHFrEFgroup(P<0.05).Theall-causereadmissionrateofHFimpEFgroupwaslowerthanthatofHFmrEFgroup(P<0.05).MultivariateCoxproportionalriskregressionanalysisshowedthatatrialfibrillation(AF)andanemiawereriskfactorsforall-causedeathinICMpatientscombinedwithHFimpEF,increasedBMIandbaselineLVEDD>55mmwereriskfactorsforall-causereadmissioninICMpatientscombinedwithHFimpEF,useofsodium-glucosecotransporter2inhibitor(SGLT2i)wasaprotectivefactorforall-causereadmissioninICMpatientscombinedwithHFimpEF(P<0.05).ConclusionAmongICMpatients,patientswithHFimpEFhaveyoungerage,lowerbloodpressure,lessdegreeofventricularremodeling,higherratesofuseofguide-recommendeddrugssuchasARNIandMRA,andlowerall-causemortalityandall-causereadmissionrates.AFandanemiaareindependentriskfactorsforall-causedeathinICMpatientscombinedwithHFimpEF.IncreasedBMIandbaselineLVEDD>55mmareindependentriskfactorsforall-causereadmissioninICMpatientscombinedwithHFimpEF.UseofSGLT2iisindependentprotectivefactorforall-causereadmissioninICMpatientscombinedwithHFimpEF.

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