缺血性心肌病不同类型心力衰竭患者冠状动脉SYNTAX积分比较

Comparison of coronary SYNTAX score in different types of heart failure with ischemic cardiomyopathy

目的比较缺血性心肌病（ICM）不同类型心力衰竭患者f临床特点及冠状动脉SYNTAX积分的差异。方法回顾性分析2010-01～2014—12在三亚市人民医院心内科因心力衰竭住院诊断为ICM并完成冠状动脉造影的i28例患者临床资料，将其分为左心室射血分数（LVEF）降低的心力衰竭又称收缩性心力衰竭（HF—REF）和LVEF保留的心力衰竭又称舒张性心力衰竭（HF—PEF），其中HF—PEF53例，HF—FIEF75例。分析两组临床特点、血浆BNP、超声改变以及冠状动脉SYNTAX积分的差异。结果HF—REF组病程长短、陈旧性心肌梗死发生率、左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、纽约心功能分级、多支血管病变、血浆BNP、SYNTAX积分等均显著高于HF—PEF组（P〈0．05）。多变量相关性分析显示，病程、心功能分级、血浆BNP与SYNTAX积分呈正相关，相关系数分别为0．227、0．443、0．513（P〈0．05），而LVEDD、LVESD、LVEF值与SYNTAX积分无显著相关（P〉0．05）。结论与HF—REF患者比较，HF—PEF患者病程较短，病情及冠状动脉病变程度较轻，预后相对较好；冠状动脉病变严重及复杂程度是ICM患者发生心力衰竭的重要影响因素。

Objective To compare the ischemic cardiomyopathy clinical characteristics of different types of heart failure and coronary SYNTAX score. Methods This retrospective analysis included 128 eases who were diagnosed as ischemic cardiomyopathy with heart failure hospitalized in the People＇s Hospital of Sanya during January 2010 to December 2014. Depending on the difference of clinical characteristics, the 128 cases were divided into HF- REF （75 cases） and HF- PEF （53 cases）. The clinical features, plasma BNP, ecbocardiography and coronary SYNTAX score difference were analyzed in both groups. Results The duration of disease, old myocardial infarction rate, left ventricular end - diastolic diameter （ LVEDD）, left ventricular systolic diameter （ LVESD）, New York Heart Association functional class, multi - vessel disease, plasma BNP, coronary SYNTAX score and many other parameters were compared, and these indexes were significantly higher in HF - REF group than those in HF - PEF group. Multivariate correlation analysis showed that coronary SYNTAX score and duration of disease, NYHA class, plasma BNP was positively correlated, and the correlation coefficient was 0. 227,0. 443 and 0. 513, respectively（ P 〈 0.05 ）, but coronary SYNTAX score and LVEDD, LVESD, LVEF value had no significant correlation （P 〉 0.05 ）. Conclusion Compared with HF - REF patients, HF- PEF patients with short duration, mild coronary artery stenosis and patient＇s condition, the prognosis is good. Complex severity of coronary artery disease is a key factor for the development of ischemic cardiomyopathy heart failure.