充血性心力衰竭患者预后因素探讨

The prognostic factors in congestive heart failure

目的：探讨充血性心力衰竭（CHF）患者的预后因素。方法：前瞻性研究163例CHF患者临床、心电图及血流动力学的预后价值，用多因素Cox回归模型分析各因素对预后的影响。结果：平均随访29个月，心脏性死亡59例，其中猝死34例，泵衰竭死亡19例，心肌梗死死亡6例；多因素分析示，平均主动脉压、平均肺动脉压和QTc是心脏性死亡的独立危险因素；生存率分析示，平均主动脉压≤12kPa，平均肺动脉压≥3．33kPa，QTc≥440ms，射血分数≤25％及有束支阻滞者，生存率显著降低。结论：低血压、QTc延长及伴肺动脉高压者预后不良，治疗中应防止过度降压和延长心肌复极。

Objective:To investigate the prognostic factors in patients with chronic congestive heart failure. Method: 163 patients with chronic congestive heart failure (83% men, age 59±9years, left ventricular ejection fraction≤40%) were studied prospectively. A detail invasive right and left heart hemodynamic and heart functional study were per formed in all patients. Result:During follow-up of 29±15 months, there were 59 cardiac death: 19 were due to progressive pump failure, 34 were sudden and 6 were due to myocardial infarction. Multivariate Cox proportional harzard analysis identified mean aortic pressure (P<0.0001),mean pulmonary artery pressure (P = 0. 0142) and QTc interval (P = 0. 0167) as independent,statistically significant predictors of total mortality. Kaplan-Meier survival analysis showed that cumulattive survival rate were significantly lower in patients with mean aortic pressure≤12 kPa,mean pulmonary artery pressure≥3. 33kPa or QTc interval≥440 ms. Couclusion: Low mean aortic pressure,prolong of QTc interval and high mean pulmonary artery pressure defined a subgroup of patients with poor prognosis.