论文部分内容阅读
目的:分析射血分数改善的心力衰竭（HFrecEF）患者的临床特征及其左心室射血分数（LVEF）改善的预测因子。方法:该研究为病例对照研究。纳入2009年1月1日至2017年12月31日因心力衰竭（心衰）在北京医院心内科住院并有随访记录的患者，根据LVEF的基线值和变化分为射血分数降低的心衰组（HFrEF组，入院时LVEF≤40%，复查时LVEF≤40%或LVEF>40%但上升幅度40%且LVEF上升幅度≥10%）和射血分数保留的心衰组（HFpEF组，入院时LVEF>40%）。通过电子病历系统收集入选患者的一般临床资料以及随访终点事件（全因死亡、心血管死亡和猝死）发生情况。采用Log-rank检验评估各组患者终点事件发生情况的差异，并绘制Kaplan-Meier生存曲线。采用logistic回归模型分析LVEF≤40%的心衰患者射血分数改善的预测因子。结果:该研究共纳入患者310例，其中HFrEF组91例（29.4%）、HFrecEF组38例（12.3%）、HFpEF组181例（58.4%）。三组间比较，HFrecEF组患者较为年轻，女性比例较高，收缩压和舒张压较高，静息心率较快，扩张型心肌病患者比例较高，陈旧性心肌梗死患者比例较低（n P均40%). Clinical data were collected and endpoint events (all-cause death, cardiovascular death and sudden death) were recorded. The Log-rank test was used to evaluate the differences of terminal events in different groups, and Kaplan-Meier survival analysis was performed. Logistic regression equation was used to identify prognostic factors of HFrecEF.Results:A total of 310 patients with heart failure were included. There were 91(29.4%) HFrEF patients, 38(12.3%) HFrecEF patients and 181(58.4%) HFpEF patients. Compared with HFrEF patients and HFpEF patients, HFrecEF patients were featured by younger age, more likely to be female, higher systolic blood pressure, diastolic blood pressure and resting heart rate (alln P<0.05). Dilated cardiomyopathies were more common, while old myocardial infarctions were less common in HFrecEF (bothn P<0.05). During a median follow-up of 36.7(18.0, 63.9) months, Kaplan-Meier survival analysis found that HFrecEF patients had the lowest all-cause mortality (Log-rankn P=0.047, HFrecEF vs. HFpEF n P=0.017, HFrecEF vs. HFrEF n P=0.016, and HFpEF vs. HFrEF n P=0.782).The cardiovascular mortality ranged from low to high was in HFrecEF patients, HFpEF patients, and HFrEF patients (Log-rankn P<0.001, HFrecEF vs. HFpEFn P=0.029, HFrecEF vs. HFrEF n P<0.001, HFrEF vs. HFpEFn P=0.005). Sudden death rate was similar among the three groups (Log-rankn P=0.520). Logistic regression analysis showed that left ventricular end-diastolic diameter (LVEDD)≤55 mm (n OR=5.922, 95%n CI 1.685-20.812, n P=0.006), higher diastolic blood pressure (n OR=1.058, 95%n CI 1.017-1.100, n P=0.005), faster resting heart rate (n OR=1.042, 95%n CI 1.006-1.080, n P=0.024), absence of old myocardial infarction (n OR=5.343, 95%n CI 1.731-16.488, n P=0.004) were independent prognostic factors of LVEF recovery after clinical treatment.n Conclusions:Patients with HFrecEF are associated with a better prognosis as compared to patients with HFrEF and HFpEF. LVEDD≤55 mm, higher diastolic blood pressure, faster heart rate,and absence of old myocardial infarction are independent prognostic factors of LVEF recovery after clinical treatment.