左心室射血分数极度降低的心肌梗死患者心功能恢复影响因素分析

Study on factors affecting left ventricular ejection fraction recovery in myocardial infarction patients with severe left ventricular systolic dysfunction

目的探讨左心室射血分数(LVEF)极度降低的心肌梗死患者的临床特点及其与LVEF变化的关系,评价临床指标对心肌梗死患者心功能恢复的预测作用。方法回顾性分析经冠状动脉造影检查明确诊断为心肌梗死的53例住院患者的临床资料,所有患者入院时的LVEF均≤0.4,且有门诊或再次住院心脏超声检查随访记录。根据治疗后LVEF的回升情况将患者分为心功能恢复良好组[射血分数差值(ΔEF)>0.05,26例]和心功能恢复欠佳组(ΔEF≤0.05,27例)。比较两组患者血管紧张素转化酶抑制剂(ACEI)、他汀类药物、β肾上腺素能受体阻滞剂使用情况,外周血肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)和N末端脑钠肽原(NT-proBNP)等实验室指标,室壁瘤发生率和心脏超声检查指标。采用二分类的Logistic回归法分析影响LVEF恢复的危险因素。结果 53例患者平均随访14个月,平均LVEF由0.366±0.040增至0.424±0.088。与心功能恢复良好组比较,心功能恢复欠佳组患者的室壁瘤发生率更高,左心室舒张末期内径(LVEDD)、左心房内径更大,差异均有统计学意义(P值均<0.05);两组间其余临床指标和用药情况的差异均无统计学意义(P值均>0.05)。LVEDD(OR=0.897,95%CI为0.819～0.983)增大是LDEF极度低下的冠状动脉性心脏病患者心功能恢复不佳的独立危险因素(P=0.021)。结论 LVEDD增大是LVEF极度低下的心肌梗死患者心功能恢复不佳的独立危险因素。

Objective To evaluate the correlation between clinical data and left ventricular ejection fraction （LVEF） change in myocardial infarction （MI） patients with severe left ventricular systolic dysfunction. Methods Totally 53 hospitalized MI patients undergoing coronary artery angiography （LVEF≤0.4, with cardiac ultrasound follow-up records from outpatient visit or re-hospitalization） were enrolled in this retrospective study. According to the LVEF level, the patients were divided into two groups; good recovery group of cardiac function （LVEF difference [△EF]〉0.05, 26 cases） and poor recovery group of cardiac function （△EF≤0.05, 27 cases）. Underlying diseases, medication, the results of blood examination, including creatine kinase isoenzyme （CK-MB）, troponin T （cTnT） and N-terminal pro-brain natriuretic peptide （NT-proBNP）, incidence of ventricular aneurysm and parameters of echocardiogram were collected and compared between two groups. Logistic regressive analysis was used to assess the risk factors affecting LVEF recovery. Results With an average follow-up time of 14 months, the mean LVEF rose from 0. 366± 0. 040 to 0. 424 ± 0. 088 in the 53 patients. There was a significantly higher incidence of ventricular aneurysm, and greater left ventricular end-diastolic diameter （LVEDD） and left atrial diameter in the poor recovery group of cardiac function than good recovery group （all P〈0.05）. The increase of LVEDD （OR=0. 897, 95% CI. 0. 819 - 0. 983） was an independent risk factor for poor recovery of cardiac function in patients with extremely low LVEF （ P =0. 021 ）. There were no statistical differences in other clinical parameters or angiotensin-converting enzyme inhibitor （AOEI）/statins/β blockers usage between two groups （all P〉0.05）. Conclusion LVEDD is an independent risk factor of poor LVEF recovery in MI patients with severe left ventricular systolic dysfunction. （Shanghai Med J, 2018, 41 ： 5-8）