心力衰竭发作前左室射血分数正常的冠心病患者的临床特点和长期预后

Clinical characters and long-term prognosis of coronary heart disease patients with preserved left ventricular ejection fraction before episode of heart failure

目的了解心力衰竭发作前左室射血分数(LVEF)正常的冠心病患者的临床特点和长期预后。方法选择DESIRE(Drug-Eluting Stent I mpact on Revascularization)数据库中LVEF≥50%的患者的病例资料进行分析,了解患者的临床特征、住院和随访死亡率。结果在DESIRE注册的LVEF≥50%的2714例血运重建术后的冠心病患者中,35例在住院期间发生心力衰竭,88.6%心力衰竭患者合并多支血管病变,肾小球滤过率<60ml/min者占37.1%。这些患者血运重建术后住院死亡率显著高于其他患者(14.3%vs1.2%,P<0.001);出院后平均随访(475±244)d,心力衰竭发作前LVEF正常的患者随访死亡率显著高于其他患者(21.4%vs2.6%,P<0.001)。结论心力衰竭发作前LVEF正常的冠心病患者多数冠状动脉病变弥漫,肾功能受损的发生率较高。这些患者行血运重建术后院内死亡率和长期随访死亡率高,提示这组患者病情重,应加强药物治疗。

Objective To evaluate the clinical characters and long-term prognosis of coronary heart disease patients with preserved left ventricular ejection fraction before episode of heart failure. Methods Data of patients with left ventricular ejection fraction （LVEF）≥50 in the DESIRE（Drug-Eluting Stent Impact on Revascularization）database were analyzed. Clinical characters and mortality during hospitalzation and follow up were recorded. Results A total of 2714 coronary heart disease patients after revascularization were registered in DESIRE database. Thirty-five of them had first heart failure episode during hospitalzation,and 88. 6% of these patients had multiple vessels disease, 37.1% had renal glomerular filtration rate less than 60ml/min. The mortality after revascularization was significantly higher in these patients than in others（ 14.3 % vs 1.2 % ,P〈0. 001）. The patients were followed up for a mean time of （475±244） days and the follow-up mortality was significantly higher in the heart failure patients with preserved LVEF during episode interval than in others（21.4%vs 2.6%,P〈0. 001）. Conclusion Coronary heart disease patients with preserved LVEF during episode interval or before episode of heart failure may have diffuse coronary stenosis and high incidence of renal impairment. They may have high mortality after revascularization and during follow up. Intensive medical therapy should be given to these patients.