右心室舒张末期内径对慢性收缩性心力衰竭患者预后的影响

Prognostic value of right ventricular end-diastolic diameter in patients with chronic systolic heart failure

目的探讨右心室舒张末期内径（RVDD）对慢性收缩性心力衰竭（心衰）患者预后的影响。方法回顾性调查和分析湖北省12家三级甲等医院2000--2010年心衰住院患者临床资料，并进行电话随访。根据RVDD将患者分为〉38mm、31～38mm、25～30mm、〈25mm4组；根据患者预后分为死亡组和存活组；死亡组中根据死亡原因分为心衰死亡组和心源性猝死组。以单因素和多因素Cox生存分析确认RVDD对总体和不同病因心衰患者预后的影响。结果16681例患者纳入本次研究，随访1～4年，死亡6453例。多因素Cox生存分析，RVDD25～30mm组、31～38mm组和〉38mm组总死亡风险分别为RVDD〈25mm组的1．87倍（95％CI：1．64～2．13，P〈0．01）、2．41倍（95％CI：2．06～2．80，Pd0．01）和3．95倍（95％CI．3．61～4．32，P〈0．01）。RVDD〉38mm组心源性猝死风险是RVDD〈25mm组3．82倍（95％CI：2．27～5．94，P〈0．01）。单独最佳预测模型与RVDD加最佳预测模型预测总死亡ROC曲线下面积分别为0．776（95％CI：0．768～0．784）和0．815（95％CI：0．808--0．822）；RVDD增加预测不同病因总死亡、心衰死亡和心源性猝死ROC曲线下面积。RVDD增加最佳预测模型构建ROC曲线可区分总体和不同病因心衰患者心衰死亡和心源性猝死。结论RVDD对慢性收缩性心功能不全患者预后存在影响；RVDD增加预测慢性收缩性心衰患者总死亡的敏感性和特异性，增加不同病因引起的心衰患者总死亡、心衰死亡和心源性猝死的敏感性和特异性；RVDD〉38mm可作为评价心衰患者猝死风险的指标。

Objective To investigate the prognostic value of right ventricular end-diastolic diameter （RVDD） in patients with chronic systolic heart failure （CHF）. Methods A retrospective study was conducted with clinical data of inpatients from 12 third-grade class-A hospitals of Hubei Province between 2000 to 2010, followed up by phone calls. Based on RVDD, patients diagnosed with chronic systolic CHF were divided into four groups： 〉38 mm, 31-38 ram, 25-30 ram and %25 mm groups; based on prognosis, patients were divided into the death group and the survival group. Of the death group, patients were further divided into the heart failure death subgroup and the sudden cardiac death subgroup. Single-factor and multi-factor Cox survival analyses were conducted to analyze the relationships between RVDD and mortality, including all-cause mortality, CHF mortality and sudden cardiac death （SCD）. Results A total of 16681 patients were enrolled in this study. They were followed up for 1-4 years, during which 6453 died. Multivariate Cox survival analysis showed that the mortality risk for patients with RVDD between 25 30 mm, between 31-38 mm, and 〉38 mm groups was 1.87, 2.41, 3.95 times that for patients with RVDD〈25 mm, respectively （95% CI： 1.64-2.13, 2.06-2.80, 3.61-4.32, all P〈0.01）. The risk of sudden cardiac death for patients with RVDD〉38 mm was 3.82 times that for patients with RVDD%25 mm （95%CI： 2.27 5.94, P〈0.01）. The areas under the ROC curve for death by the best prediction model alone and RVDD combined with the best prediction model were 0. 776 （ 95% CI： 0. 768-0. 784） and 0. 815 （ 95% CI： 0. 808-0. 822 ）,respectively. RVDD increased the areas under the ROC curve for all-cause mortality, CHF mortality and sudden cardiac death. The best prediction model combined with RVDD could discriminate between total mortality, heart failure mortality and sudden cardiac death for patients with different causes of death in multivariate analysis. Conclusions RVDD has a predictive value in the prognosis of patients with chronic systolic heart failure. RVDD increases the sensitivity and specificity of the best prediction model for total mortality prediction in patients with chronic systolic heart failure. RVDD increases the sensitivity and specificity of the best prediction model to discriminate between all cause mortality, heart failure mortality and sudden cardiac death in patients with different causes of death. RVDD〉38 mm can serve as an indicator for the assessment of sudden cardiac death in CHF patients.