摘要
目的评估肺有效动脉弹性(Ea)在心力衰竭(心衰)患者长期预后评估中的潜在价值。方法该研究为回顾性队列研究,纳入2013年9月至2022年2月在阜外医院心衰中心行漂浮导管检查的284例心衰患者。收集患者的基线临床资料、血流动力学数据及预后信息。Ea的计算公式为平均肺动脉压/每搏输出量。根据Ea的中位数值(0.555 mmHg/ml,1 mmHg=0.133 kPa)将患者分为Ea<0.555组和Ea≥0.555组。主要终点为主要临床事件,设定为包括全因死亡、心脏移植、左心室辅助装置植入和因心衰再住院的复合事件。无事件生存定义为未发生主要临床事件。采用Spearman相关性分析Ea与右心功能指标的相关性。采用Kaplan-Meier法进行生存分析,log-rank法比较两组间无事件生存率差异。采用Cox比例风险回归模型分析Ea与主要临床事件的关联,并根据研究对象的年龄、性别、纽约心脏协会(NYHA)心功能分级、左心室射血分数、是否合并肺动脉高压以及N末端B型利钠肽原(NT-proBNP)水平进行亚组分析。采用受试者工作特征(ROC)曲线计算Ea预测心衰患者无事件生存的曲线下面积(AUC)。结果所有患者的中位年龄为51岁,男性206例(72.5%)。Ea与肺动脉顺应性(r=-0.888,P<0.001)和肺血管阻力(r=0.698,P<0.001)显著相关。与Ea<0.555组相比,Ea≥0.555组患者的NT-proBNP水平[4443(1792,8554)ng/L比1721(480,4528)ng/L,P<0.001]、肺血管阻力[3.4(2.5,4.7)Wood比1.4(0.9,2.2)Wood,P<0.001]更高,心输出量[3.0(2.3,3.9)L/min比4.3(3.8,4.9)L/min,P<0.001]、肺动脉顺应性[1.6(1.3,2.0)ml/mmHg比4.0(3.0,6.0)ml/mmHg,P<0.001]更低。中位随访时间392(166,811)d,Kaplan-Meier生存曲线显示,Ea≥0.555组的无事件生存率低于Ea<0.555组(P_(log-rank)<0.001)。多因素Cox回归分析结果显示,Ea是主要终点的独立预测因子(HR=1.734,95%CI 1.314~2.289,P<0.001)。亚组分析表明,Ea对各类心衰人群均存在预测价值(P均<0.05)。Ea预测心衰患者无事件
Objective To explore the predictive value of pulmonary effective arterial elastance(Ea)in patients with heart failure(HF).Methods This is a retrospective cohort study,which retrospectively included 284 patients with HF who underwent right heart catheterization at Heart Failure Center in Fuwai Hospital between September 2013 and February 2022.Data regarding baseline clinical characteristics,hemodynamic profiles,and prognosis were collected.Ea was calculated as mean pulmonary arterial pressure/stroke volume.Patients were divided into Ea<0.555 group and Ea≥0.555 group according to the median value of Ea(0.555 mmHg/ml,1 mmHg=0.133 kPa).The primary outcome was the primary clinical event,set as the first occurrence of a series of composite events,including all-cause death,heart transplantation,left ventricular assist device implantation,and HF rehospitalization.Event-free survival was defined as the absence of primary clinical events.Spearman correlation analysis was used to calculate the correlation coefficient between Ea and parameters reflective of right heart function.The Kaplan-Meier analysis was used to compare the different groups for the estimation of outcomes with the log-rank test.We used Cox proportional-hazards regression models to estimate hazard ratios(HR)for primary clinical event.Subgroup analysis was performed based on the age,gender,New York Heart Association(NYHA)functional class,left ventricular ejection fraction,presence of pulmonary hypertension,and serum N-terminal pro-B-type natriuretic peptide(NT-proBNP)values.We used receiver operating characteristic(ROC)curve to calculate the area under the curve(AUC)of Ea for predicting event-free survival in patients with HF.Results The median age was 51 years,and 206(72.5%)patients were male.Ea and pulmonary vascular resistance(PVR)were significantly correlated(r=0.698,P<0.001).The correlation between Ea and pulmonary arterial elastance(PAC)were even more significant(r=-0.888,P<0.001).Compared with Ea<0.555 group,Ea≥0.555 group presented with higher se
作者
吴易航
黄博平
冯佳禹
黄丽燕
赵雪梅
王静
关敬元
李心晴
张宇辉
张健
Wu Yihang;Huang Boping;Feng Jiayu;Huang Liyan;Zhao Xuemei;Wang Jing;Guan Jingyuan;Li Xinqing;Zhang Yuhui;Zhang Jian(Heart Failure Center,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2024年第4期397-404,共8页
Chinese Journal of Cardiology
基金
国家“十三五”科技支撑计划重点项目(2017YFC1308300)。
关键词
心力衰竭
右心功能
肺有效动脉弹性
血流动力学
预后
Heart failure
Right ventricular function
Pulmonary effective arterial elastance
Hemodynamics
Prognosis
