摘要
目的观察不同程度功能性二尖瓣反流(FMR)对射血分数降低的心力衰竭(HFrEF)患者预后的影响。方法纳入2013年1月至2019年9月期间于新疆医科大学第一附属医院心脏中心住院的HFrEF伴不同程度FMR患者818例,中位随访24个月,根据超声心动图FMR严重程度,将患者分为轻度(118例)、中度(472例)、重度(228例)3组。分析3组患者临床特点及随访期间主要复合终点(全因死亡和/或心力衰竭再入院)的发生率,采用Kaplan-Meier生存曲线法比较三组患者生存情况。采用Cox风险比例回归模型分析HFrEF伴不同程度FMR患者罹患主要复合终点的影响因素。结果在24月随访期间,共有376例(46.0%)研究对象发生主要复合终点,其中死亡156例(19.4%),因心衰再入院302例(36.9%)。随着FMR程度加重,主要复合终点发生率升高(轻度、中度及重度FMR分别为29.7%、46.0%及54.4%),差异有统计学意义(P<0.01)。Kaplan-Meier生存分析结果显示,轻度FMR患者的无事件生存率高于中、重度FMR患者(P<0.01)。多因素Cox回归分析结果显示,调整混杂因素后,中度和重度FMR患者发生主要复合终点的风险是轻度FMR患者的1.265倍[风险比(HR)1.265,95%可信区间(CI)1.181~3.329,P=0.034]和4.302倍(HR 4.302,95%CI 1.648~11.234,P=0.003]。结论在HFrEF伴不同程度FMR患者中,中、重度FMR发生主要复合终点的比例明显高于轻度FMR,是HFrEF长期不良预后的独立预测因子。
Objective To observe the impact of different degrees of functional mitral regurgitation(FMR)on the prognosis of heart failure with reduced ejection fraction(HFrEF)patients.Methods Patients hospitalized in Heart Center of First Affiliated Hospital of Xinjiang Medical University with the diagnosis of HFrEF and different degrees of FMR between January 2013 and September 2019 were included,and divided into three subgroups(mild,moderate and severe FMR)according to the severity of FMR by echocardiography.The clinical characteristics of the three subgroups and the incidence of the primary composite endpoint(all-cause death and/or heart failure readmission)during follow-up were analyzed.The survival of the three groups were compared by Kaplan-Meier survival curve method.Cox risk proportional regression model was used to analyze the influencing factors of the main composite endpoint in patients with HFrEF and different degrees of FMR.Results A total of 818 patients were included,of which mild group,moderate group and severe group were 118,472 and 228 patients.After a median follow-up duration of 24 months,376 cases(46.0%)had primary composite endpoint,including 156 deaths(19.4%)and 302 readmissions due to heart failure(36.9%).With the aggravation of FMR,the incidence of the main composite endpoint increased(mild 29.7%,moderate 46.0%and severe 54.4%)(P<0.01).Kaplan-Meier survival analysis showed that the event-free survival of patients with mild FMR was significantly higher than that of patients with moderate and severe FMR(P<0.01).After adjusting for confounding factors,multivariate Cox regression analysis showed that the risk of primary composite endpoint in patients with moderate FMR was 1.265 times[hazard ratio(HR)1.265,95%confidence interval(CI)1.181-3.329,P=0.034]and severe FMR was 4.302 times(HR 4.302,95%CI 1.648-11.234,P=0.003)higher than that in patients with mild FMR.Conclusion In HFrEF patients with different degrees of FMR,the proportion of primary composite endpoints of moderate and severe FMR is significantly
作者
玉苏甫江·阿布来提
热甫开提·阿不都哈力克
孙娟
艾力曼·马合木提
Yusufujiang·Abulaiti;Refukaiti·Abuduhalike;Sun Juan;Ailiman·Mahemuti(Department of Heart Failure,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)
基金
新疆维吾尔自治区自然科学基金重点项目(2021D01D17)。
关键词
功能性二尖瓣反流
射血分数降低的心力衰竭
预后
Heart failure with reduced ejection fraction
Functional mitral regurgitation
Prognosis
