超声心动图在老年高血压射血分数保留型心力衰竭临床诊断及预后评估中的应用价值

Application value of echocardiography in clinical diagnosis and prognosis evaluation of

目的:观察超声心动图在老年高血压射血分数保留型心力衰竭(HFpEF)临床诊断及预后评估中的应用价值。方法:选取2020年1月―2023年4月我院收治的196例老年高血压患者为研究对象,根据是否合并HFpEF,将合并HFpEF患者纳入研究组(n=96),不合并HFpEF患者纳入对照组(n=100),比较两组超声心动图参数,采用受试者工作特征(ROC)曲线分析其对高血压HFpEF的临床诊断价值。根据患者出院后3个月内是否发生主要不良心血管事件(MACE)将研究组患者分为预后良好组与预后不良组,探究患者预后的影响因素。结果:研究组患者超声心动图参数中舒张期室间隔厚度(IVSTD)、舒张期左心室内径(LVDd)、舒张期左心室后壁厚度(LVPWTD)及左室心肌质量指数(LVMI)均高于对照组。ROC特征曲线结果显示,IVSTD诊断高血压HFpEF的最佳截断值为0.985 mm,LVDd最佳截断值为4.085 mm,LVPWTD最佳截断值为0.965 mm,LVMI最佳截断值为114.175 g/m2,且四者联合诊断高血压HFpEF的AUC及敏感度均高于单一指标预测。预后不良组患者血红蛋白(Hb)水平及左室射血分数(LVEF)低于预后良好组,心功能分级、LVMI及心肌能量消耗(MEE)高于预后良好组,且多因素Logistic回归分析结果显示,Hb、心功能分级、LVEF及MEE是高血压HFpEF患者预后水平的独立影响因素。结论:与不合并HFpEF老年高血压患者比较,老年高血压合并HFpEF患者超声心动图参数中IVSTD、LVDd、LVPWTD及LVMI更高,且四项指标联合诊断高血压HFpEF的应用价值较高,同时Hb、心功能分级、LVEF及MEE是高血压HFpEF患者预后的独立影响因素,建议临床予以重点关注。

Objective To evaluate the application value of echocardiography in clinical diagnosis and prognosis evaluation of heart failure with preserved ejection fraction(HFpEF)in elderly patients with hypertension.Methods A total of 96 elderly hypertension with HFpEF patients who were admitted to the hospital from January 2020 to April 2023 were selected as the study subjects.Among them,patients with HFpEF were included in the study group(n=96)and those without HFpEF were included in the control group(n=100).The echocardiographic parameters of the two groups were compared,and the clinical value of echocardiography in diagnosing hypertension and HFpEF was analyzed using the receiver operating characteristic(ROC)curve.Patients in the study group were divided into the good prognosis group and the poor prognosis group according to the presence or absence of major adverse cardiovascular events(MACE)within 3 months after discharge.The prognostic factors were explored.Results IVSTD,LVDd,LVPWTD and LVMI in the study group were higher than those in the control group.ROC curve analysis found that the optimal cutoff values of IVSTD,LVDd,LVPWTD and LVMI for diagnosing hypertension and HFpEF were 0.985 mm,4.085 mm,0.965 mm and 114.175 g/m2,respectively.The AUC and sensitivity of the combined diagnosis of hypertension and HFpEF were higher than those of single diagnosis.Hb level and LVEF in the poor prognosis group were lower than those in the good prognosis group.The grade of cardiac function,LVMI and MEE were higher than those in the good prognosis group.Multivariate logistic regression analysis found that Hb,the grade of cardiac function,LVEF,and MEE were independent influencing factors for the prognosis of hypertension and HFpEF.Conclusion Compared with elderly hypertension patients without HFpEF,elderly hypertension with HFpEF patients have larger IVSTD,LVDd,LVPWTD and LVMI.The combination of these four indicators is of high application value in diagnosing hypertension with HFpEF.Hb,the grade of cardiac function,LVEF,and MEE are independent prognostic factors in hypertension with HFpEF patients,which deserves special attention in clinical practice.