瓣膜病合并射血分数降低的心力衰竭患者术后左心室功能恢复的影响因素分析

Analysis of factors affecting postoperative left ventricular function recovery in patients with valvular disease combined with heart failure with reduced ejection fraction

目的分析瓣膜病合并射血分数降低的心力衰竭[heart failure with reduced ejection fraction,HFrEF;左心室射血分数(left ventricular ejection fraction,LVEF)<40%]患者瓣膜手术后心功能恢复的影响因素。方法回顾性分析2011年1月至2018年6月于我院行手术治疗的LVEF<40%的98例瓣膜病患者临床资料,其中男75例、女23例,年龄9~78(55.3±11.9)岁。结果全组患者共死亡15例,术后3个月内死亡4例,术后中远期死亡11例。术后91例患者随访6个月以上,随访时间10个月至8.6年。91例患者术后心功能分级(NYHA)均为Ⅰ~Ⅱ级,18例(19.8%)患者LVEF恢复10%以上,47例(51.6%)患者LVEF保持术前水平,26例(28.6%)患者LVEF降低。HFrEF瓣膜病患者术后LVEF易恢复的因素包括术前仍为窦性心律(P=0.038)、以主动脉瓣病变为主的瓣膜病(P=0.026)、术后早期即出现左心室舒张末期内径明显缩小(P=0.017)及术前肺动脉收缩压较高(P=0.018);术后LVEF可能出现降低的危险因素包括术前左心房较大(P=0.014)、术前左心室收缩末期内径较小(P=0.003)、术后心率较快不容易控制(P=0.019)。结论二尖瓣脱垂患者出现左心室内径明显增大时,应尽早手术;HFrEF的主动脉瓣病变患者应积极手术,预后较好;HFrEF瓣膜病患者若肺动脉收缩压较高,预后通常较好。

Objective To analyze factors affecting the recovery of postoperative left ventricular function in patients with valvular disease combined with heart failure with reduced ejection fraction[HFrEF,left ventricular ejection fraction(LVEF)<40%].Methods The clinical data of 98 patients with valvular disease combined with HFrEF who underwent surgeries in our hospital from January 2011 to June 2018 were retrospectively analyzed,including 75 males and23 females aged 9-78(55.3±11.9)years.Results A total of 15 patients were dead after the operation,including 4 deaths within 3 months and 11 mid-long-term deaths after the operation.Ninety-one patients were followed up for more than 6 months(10 months to 8.6 years).The postoperative cardiac function(NYHA)of 91 patients was classⅠ-Ⅱ,the LVEF of 18(19.8%)patients increased more than 10%,that of 47(51.6%)patients maintained at the preoperative level,and that of 26(28.6%)patients decreased.Postoperative LVEF was more prone to recover in HFrEF patients with sinus rhythm before operation(P=0.038),valvular disease mainly in aortic valve(P=0.026),obvious reduction of left ventricular end diastolic diameter in early postoperative period(P=0.017),and higher systolic pulmonary artery pressure(SPAP)before operation(P=0.018).The risk factors for postoperative LVEF deterioration included large left atrium before operation(P=0.014),smaller left ventricle end systolic diameter before operation(P=0.003),and fast heart rate after operation(P=0.019).Conclusion Mitral valve prolapse patients with obviously increased left ventricular diameter should receive operation as soon as possible.HFrEF patients with aortic valve disease should receive operation positively.The operation efficacy is satisfactory in the HFrEF patients with high SPAP.