左室舒张末压对舒张性心力衰竭患者预后的预测价值

Predictive value of left ventricular end-diastolic pressure in patients with diastolic heart failure

目的:评价左室舒张末压(LVEDP)对舒张性心力衰竭(心衰)患者的预后预测价值。方法:使用左心导管测定舒张性心衰患者的LVEDP,并进行随访。根据随访结果比较无心源性事件组和心源性复合终点事件组的LVEDP水平;通过患者的ROC曲线划分有无心源性事件发生的最佳阈值点,根据该阈值点划分2组并运用KaPlan-Meier法分析其生存率;采用多因素COX回归分析法。结果:171例患者平均随访(15.70±3.43)个月,心源性复合终点事件组的LVEDP水平为17.5(9.4,20.1)mmHg,显著高于无心源性事件组的12.5(7.4,16.3)mmHg(P=0.032)。根据ROC曲线,LVEDP15.1mmHg为划分有无心源性事件发生的最佳阈值点,LVEDP<15.1mmHg的患者无心源性事件生存时间约是LVEDP>15.1mmHg患者的1.32倍(16.46个月∶12.43个月,P=0.007)。COX多元回归分析发现,LVEDP和BNP是心脏复合终点事件的独立相关影响因素,其中又以LVEDP的相关性更强。结论:LVEDP对舒张性心衰患者的预后预测价值好,LVEDP和BNP是心脏复合终点事件的独立相关影响因素。

Objective：To evaluate the predictive value of left ventricular end-diastolic pressure （LVEDP） for patients with diastolic heart failure （DHF）. Method：LVEDP in patients with DHF was examined by left cardiac catheter. Cardiac composite end point events were cardiac death and re-admission. According to the follow-up results, we compared LVEDP levels of cardiac composite end point events group with non-cardiac composite end point events group, and searched for the cut off point by ROC. According to the cut off point about LVEDP level, all the patients were divided into two groups and used KaPlan-Meier method to analysis survival rates. Cox regression analysis was performed to assess the factors that affecting cardiac composite end point events. Result：A total of 171 patients were followed up （15.70±3.43）months. The LVEDP level in cardiac composite end point events group [17.5（9.4, 20.1）mmHg, 1 mmHg=0.133 kPa] was higher than that in non-cardiac composite end point events group [12.5（7.4, 16.3）mmHg] （P=0.032）. The cut off point of LVEDP level was 15.1 mmHg. Multivariate Cox analysis ahowed that LVEDP and BNP remained as the significant predictors of cardiac events, especially LogLVEDP. Conclusion：LVEDP has good predictive value for the clinical prognosis of patients with DHF. LVEDP and BNP are independent influencing factors for the cardiac composite end point events.