心脏电-机械活动时间比值对慢性心力衰竭患者发生院内心脏不良事件的预测价值

Predictive value of cardiac electro-mechanical activity time ratio for in-hospital adverse cardiac events in patients with chronic heart failure

目的评价心脏电-机械活动时间比值（EMAT%）对慢性心力衰竭患者发生院内心脏不良事件的预测价值。方法选择2015年8月至2017年5月于首都医科大学附属北京安贞医院入院治疗的慢性心力衰竭的患者129例。根据是否出现心脏不良事件，将患者分为心脏不良事件组（22例）和无心脏不良事件组（107例）。记录并比较2组患者基本资料、临床指标、心功能指标和主要药物治疗情况。采用二元Logistic回归分析患者发生院内心脏不良事件的独立危险因素。采用受试者工作特征（ROC）曲线分析EMAT%对患者发生院内心脏不良事件的预测价值。结果心脏不良事件组心率、肌钙蛋白I、B型钠尿肽和EMAT%水平高于、左心室射血分数水平低于无心脏不良事件组［98（81,122）次/min比82（72,94）次/min、0.650（0.060,7.235）μg/L比0.070（0.020,1.710）μg/L、1 037.0（653.5,1 905.5）ng/L比565.0（166.0,1 010.0）ng/L、（17±3）%比（13±3）%、（32±7）%比（38±8）%］，差异均有统学意义（均P＜0.05）。心脏不良事件组β受体阻滞剂使用比例低于无心脏不良事件组［36.4%（8/22）比69.2%（74/107）］,差异有统计学意义（P＜0.05）。二元Logistic回归分析显示EMAT%是慢性心力衰竭患者发生院内心脏不良事件的独立危险因素（比值比=1.488, 95%置信区间： 1.204～1.840,P＜0.001）。ROC曲线分析显示，EMAT%对其预测的曲线下面积为0.822（95%置信区间：0.728～0.917, P＜0.05），以EMAT%=13.9%为界值，预测慢性心力衰竭患者发生院内心脏不良事件的敏感度为86.4%，特异度为68.2%。结论EMAT%升高可能是慢性心力衰竭患者发生院内心脏不良事件的独立危险因素，可用来甄别重症慢性心力衰竭患者。

ObjectiveTo explore the predictive value of cardiac electro-mechanical activity time ratio（EMAT%） for in-hospital adverse cardiac events in patients with chronic heart failure. MethodsTotally 129 patients with chronic heart failure from August 2015 to May 2017 in Beijing Anzhen Hospital, Capital Medical University were divided into adverse cardiac events group（22 cases） and non-adverse cardiac events group（107 cases）. Basic data, clinical indexes, cardiac function indexes and medications were recorded. Risk factors of in-hospital adverse cardiac events were analyzed by binomial logistic regression. The predictive value of EMAT% for in-hospital cardiac adverse events was analyzed by the receiver operating characteristic（ROC） curve. ResultsHeart rate, troponin I, B-type natriuretic peptide and EMAT% in adverse cardiac events group were significantly higher and left ventricular ejection fraction was significantly lower than those in non-adverse cardiac events group[98（81,122）times/min vs 82（72,94）times/min, 0.650（0.060,7.235）μg/L vs 0.070（0.020,1.710）μg/L, 1 037.0（653.5,1 905.5）ng/L vs 565.0（166.0,1 010.0）ng/L, （17±3）% vs （13±3）%, （32±7）% vs （38±8）%]（P〈0.05）. The use ratio of β-blockers in adverse cardiac events group was significantly lower than that in non-adverse cardiac events group[36.4%（8/22） vs 69.2%（74/107）]（P〈0.05）. Logistic regression analysis showed that EMAT% was an independent risk factor of in-hospital adverse cardiac events （odds ratio=1.488, 95% confidence interval： 1.204-1.840, P〈0.001）. The area under ROC curve of EMAT% in predicting in-hospital cardiac adverse events was 0.822（95%CI： 0.728-0.917, P〈0.05）; the cut-off value was 13.9%; the sensitivity was 86.4% and the specificity was 68.2%. ConclusionElevated EMAT% may be an independent risk factor of in-hospital adverse cardiac events in patients with chronic heart failure.