冠状动脉疾病患者经皮冠状动脉介入治疗后舒张功能障碍的预后意义

Prognostic significance of diastolic dysfunction in coronary artery disease patients after PCI

目的探讨冠状动脉疾病患者经PCI后左心室舒张功能障碍的预后意义。方法连续选择2010年8月~2014年8月在我院接受PCI药物洗脱支架的患者798例,后续5年的随访中,根据超声心动图检查显示的左心室舒张功能,将患者分为恶化组144例、未变组410例和改善组244例。患者PCI术前后均行超声心动图检查,根据二尖瓣口血流舒张早期最大峰值速度(E)和舒张晚期最大峰值速度(A)比值等项目,将左心室舒张功能分正常、1、2和3级。记录临床结局,其中主要结局是主要不良心脏事件(MACE),次要结局为全因死亡、心源性死亡或心肌梗死,用Cox比例风险模型分析发生临床结局风险。结果入选患者中,基线舒张功能障碍患者667例(83.6%),其中1级障碍占64.6%。舒张功能恶化18.0%、舒张功能未改变51.4%、舒张功能改善或正常30.6%。与PCI术前比较,PCI术后恶化组患者E/A比值显著升高(1.05±0.18 vs 0.71±0.19,P<0.05)。在超声心动图初次随访后的5年中,恶化组MACE发生率高于未变组和改善组(41.7%vs 21.5%和13.5%,P<0.01)。Cox比例风险模型分析显示,恶化组较未变组和改善组发生MACE风险显著升高,调整后的风险仍高于未变组和改善组(HR=2.12,95%CI:1.60~2.84;HR=2.22,95%CI:1.53~3.34,P<0.01);且恶化组发生次要结局的风险显著高于未变组和改善组(P<0.05)。结论在PCI患者中,左心室舒张功能恶化与发生MACE风险增加独立相关。评估PCI术后左心室舒张功能的变化可能是预测长期临床结局的一种简单而有效的方法。

Objective To study the prognostic significance of diastolic dysfunction in coronary artery disease(CAD)patients after PCI.Methods Seven hundred and ninety-eight CAD patients who underwent PCI and drug eluting stenting in our hospital from August 2010 to August 2014 were divided into diastolic dysfunction group(n=144),normal diastolic function group(n=410)and improved diastolic function group(n=244)according to their 5-year follow-up data.The patients underwent echocardiography before and after PCI.The diastolic function of their left ventricle was divided into normal,and 1-3 grades.The incidence of MACE,all-cause deaths,cardiogenic deaths and myocardial infarction was recorded and their risk was analyzed according to the Cox harzards model.Results Baseline diastolic dysfunction was diagnosed in 667 patients(83.6%)with grade 1 diastolic dysfunction,diastolic dysfunction,normal or improved diastolic function accounted for 64.6%,18.0%,51.4%and 30.6%respectively.The E/A ratio was significantly higher after PCI than before PCI in diastolic dysfunction group(1.05±0.18 vs 0.71±0.19,P<0.05).Echocardiography showed that the incidence of MACE was significantly higher in diastolic dysfunction group than in normal and improved diastolic function groups during the 5-year follow-up(41.7%vs 21.5%and 13.5%,P<0.01).Cox harzards model showed that the incidence of MACE was significantly higher in diastolic dysfunction group than in normal and improved diastolic function groups after adjustment for risk(HR=2.12,95%CI:1.60-2.84,HR=2.22,95%CI:1.53-3.34,P<0.01).The risk of all-cause deaths,cardiogenic deaths and myocardial infarction was significantly higher in diastolic dysfunction group than in normal and improved diastolic function groups(P<0.05).Conclusion Diastolic dysfunction of left ventricle is independently related with the risk of MACE in CAD patients after PCI.It is thus a simple and effective method to assess the diastolic function of left ventricle for predicting the long-term clinical outcome in CAD patients after PCI.