心肺耐力与老年急性心力衰竭患者预后的关系

Relationship between cardiopulmonary fitness and prognosis in elderly patients with acute heart failure

目的探讨心肺耐力（CRF）与老年急性心力衰竭（AHF）患者预后的关系。方法纳入584例老年AHF患者，计算其CRF并进行随访。将CRF高于和低于其平均值者分别定义为高CRF组和低CRF组。采用Log—rank检验和Cox多元回归分析评价CRF与心血管事件（因AHF再次入院和心源性死亡）的关系。结果364例男性和220例女性患者的CRF分别为（10．6±1．7）METs和（8．3±1．3）METs。584例患者的中位随访时间为14．7个月，364例男性患者中有147例（40．4％）发生心血管事件，其中低CRF组心血管事件的发生率（52．7％，96／182）高于高CRF组（28．0％，51／182，P〈0．01）。220例女性患者中有83例（37．7％）发生心血管事件，其中低CRF组心血管事件的发生率（50．9％，56／110）高于高CRF组（24．5％，27／110，P〈0．01）。校正相关危险因素后，Cox多元回归分析结果显示，CRF与老年AHF患者发生心血管事件密切相关，在男性患者中，HR为0．84，95％C1为0．79—0．93（P〈0．01）；在女性患者中，HR为0．86，95％CI为0．77～0．94（P〈0．01）。结论心肺耐力与老年AHF患者发生心血管事件密切相关，提高心肺耐力可能有助于改善其预后。

Objective To explore the relationship between cardiopulmonary fitness （CRF） and prognosis in elderly patients with acute heart failure（AHF）. Methods CRF of 584 elderly patients with AHF was calculated and followed up. The high CRF group and low CRF group were defined as their CRF above and below the mean value. The relationship between CRF and cardiovascular events （re-admission due to AHF and cardiac death） was assessed by Log-rank analysis and Cox multivariate regression analysis. Results CRF of 364 male patients and 220 female patients were （ 10. 6 ± 1.7） METs and （8.3 ± 1.3） METs respectively. Median follow-up time of 584 patients was 14.7 months. Cardiovascular events occurred in 147 patients（40.4% ） of 364 male patients,and the occurrence of low CRF group（52.7% ,96/182） was higher than that of high CRF group （28.0%, 51/182, P 〈 0.01 ）. Cardiovascular events occurred in 83 patients（37.7% ） of 364 female patients, and the occurrence of low CRF group （ 50.9%, 56/110 ） was higher than that of high CRF group（24.5% ,27/110,P 〈0.01 ）. After adjusting relevant risk factors, Cox multivariate regression analysis showed that CRF was closely related to cardiovascular events in elderly patients with AHF, and HR was 0. 84 （95% CI 0. 79-0. 93 ） in male patients and 0. 86 （ 95% CI 0. 77-0.94） in female patients with statistical significance（P 〈0. 01）. Conclusion CRF is associated with cardiovascular events in elderly patients with AHF and enhancing CRF may improve the prognosis.