右心房压与不同类型慢性心力衰竭患者左心功能及预后的相关性

Correlation between right atrial pressure and left ventricular function and prognosis in patients with different types of chronic heart failure

目的探讨右心房压与不同类型慢性心力衰竭患者左心功能及预后的相关性。方法选取2018年2月至2021年3月文昌市人民医院收治的慢性心力衰竭患者211例作为研究对象,按照左心室射血分数(LVEF)将所有患者分为LVEF降低的心力衰竭(HFrEF)组84例(LVEF<40%)、LVEF轻度降低的心力衰竭(HFmrEF)组51例(40%≤LVEF<50%)和LVEF保留的心力衰竭(HFpEF)组76例(LVEF≥50%),并根据预后情况将不同类型慢性心力衰竭患者分为预后良好组和预后不良组。观察三组患者一般资料、出院时实验室指标、超声心动图指标(右心房压、左心功能)等,采用Pearson相关性分析右心房压与不同类型慢性心力衰竭患者左心功能的相关性。分别采用多因素Logistic分析不同类型慢性心力衰竭患者预后影响因素。结果Pearson相关性分析显示:右心房压与HFrEF患者LVEF呈负相关(r=-0.834,P<0.01);与HFmrEF患者LVEF呈负相关(r=-0.595,P<0.01);与HFpEF患者LVEF呈负相关(r=-0.832,P<0.01);随访观察1年,HFrEF组中失访1例,最终纳入83例,其中预后不良32例;HFmrEF组中失访1例,最终纳入50例,其中预后不良20例;HFpEF组中失访1例,最终纳入75例,其中预后不良30例;单因素分析显示,HFrEF患者中两组B型利钠肽(BNP)、右心房压对比差异有统计学意义(P<0.05);HFmrEF患者中两组BNP、右心房压对比差异有统计学意义(P<0.05);HFpEF患者中两组心房颤动占比、BNP、右心房压对比差异有统计学意义(P<0.05);多因素Logistic回归分析显示:BNP为HFrEF预后不良的危险因素[OR(95%CI)=1.003(1.000~1.006),P<0.05];BNP为HFmrEF患者预后不良的危险因素[OR(95%CI)=1.008(1.003~1.013),P<0.05];BNP、心房颤动、右心房压为HFpEF患者预后不良的危险因素[OR(95%CI)=1.004(1.001~1.008)、4.179(1.110~15.731)、1.605(1.102~2.338),P<0.05]。结论在不同类型慢性心力衰竭患者中,右心房压越大,患者左心功能越差,右心房压与HFpEF患者预后有关且为HFpEF患者预后的影响因素。

Objective To explore the correlation between right atrial pressure and left ventricular function and prognosis in patients with different types of chronic heart failure.Methods A total of 211 patients with chronic heart failure admitted to Wenchang People's Hospital of Hainan Province from February 2018 to March 2021 were selected as research object.According to left ventricular ejection fraction(LVEF),all patients were divided into heart failure with reduced ejection fraction(HFrEF)group(LVEF<40%,84 cases),heart failure with mildly reduced ejection fraction(HFmrEF)group(40%≤LVEF<50%,51 cases),and heart failure with preserved ejection fraction(HFpEF)group(LVEF≥50%,76 cases).General data,laboratory indexes at discharge and echocardiography indexes(right atrial pressure,left ventricular function)of three groups were observed.Pearson’s correlation was used to analyze the correlation between right atrial pressure and LVEF of left ventricular function in patients with different types of chronic heart failure.Meanwhile,prognosis of all patients was followed up.Patients with different types of chronic heart failure were divided into good prognosis group and bad prognosis group accordingly.Multivariate logistic analysis was used to analyze the influencing factors of prognosis of patients with different types of chronic heart failure.Results Pearson’s correlation analysis showed that right atrial pressure was negatively correlated with LVEF in patients of all three groups(HFrEF r=-0.834,P<0.01;HFmrEF r=-0.595,P<0.01;HFpEF r=-0.832,P<0.01).After 1 year's follow-up,1 case was lost to follow-up in HFrEF group,and finally 83 cases were included,of which 32 cases had poor prognosis.In HFmrEF group,1 case was lost to follow-up,and finally 50 cases were included,of which 20 cases had poor prognosis.In HFpEF group,1 case was lost to follow-up,and 75 cases were included,of which 30 cases had poor prognosis.Univariate analysis showed there were statistically significant differences in brain natriuretic peptide(BNP)and right atrial pressure between two groups of HFrEF patients(P<0.05),and also between two groups of HFmrEF patients(P<0.05).There were significant differences in atrial fibrillation ratio,BNP and right atrial pressure between two groups of HFpEF patients(P<0.05).Multivariate logistic regression analysis showed that BNP was a risk factor for poor prognosis in HFrEF[OR(95%CI)=1.003(1.000-1.006),P<0.05]and HFmrEF patients[OR(95%CI)=1.008(1.003-1.013),P<0.05].BNP,atrial fibrillation and right atrial pressure were risk factors for poor prognosis in HFpEF patients[OR(95%CI)=1.004(1.001-1.008),4.179(1.110-15.731),1.605(1.102-2.338);P<0.05].Conclusion In patients with different types of chronic heart failure,the greater the right atrial pressure is,the worse the left ventricular functions.Right atrial pressure is related to the prognosis of HFpEF patients,and is an influential factor for the prognosis of HFpEF patients.