缺血性心肌病CABG术后左心室射血功能恢复不良的相关因素分析

Analysis of related factors of poor recovery of left ventricular ejection function after ischemic cardiomyopathy CABG

目的探究缺血性心肌病患者行冠状动脉旁路移植术(CABG)进行血运重建后,左心室射血功能的获益及其影响因素。方法回顾性分析2015年3月至2019年3月于青岛市市立医院行CABG、术前左心室射血分数(LVEF)在30%~40%之间的226例缺血性心肌病患者资料,随访至术后6个月,观察LVEF恢复情况,LVEF增加≥10%为恢复良好组,LVEF增加<10%为恢复不良组,分析可能造成差异的临床、实验室、超声心动图等相关因素。结果226例患者中,121例(53.5%)术后左心室功能恢复良好。单因素分析显示,缺血性心肌病(30%≤LVEF≤40%)患者术后LVEF恢复情况与既往心肌梗死、术前心绞痛发作、N末端B型利钠肽原(NT-proBNP)水平、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)和左心室舒张末期容积(LVEDV)有关。多因素分析显示,术前无心绞痛发作、LVEDD增大是缺血性心肌病(30%≤LVEF≤40%)患者术后LVEF恢复不良的独立危险因素(OR=3.898、1.214,P<0.05),其中LVEDD≥60 mm与其恢复不良存在相关性(χ^2=8.631,OR=2.214,95%CI为1.252~3.981,P=0.005)。LVEDD≥60 mm预测缺血性心肌病(30%≤LVEF≤40%)患者术后LVEF恢复不良的灵敏度为74.6%,特异度为47.5%。结论LVEDD增大、手术近期无心绞痛发作是缺血性心肌病(30%≤LVEF≤40%)患者CABG术后LVEF恢复不良的独立危险因素,LVEDD≥60 mm可作为术前射血功能获益较小的预测指标。

Objective To investigate the benefit of left ventricular ejection function and its influencing factors in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting(CABG)after revascularization.Methods A retrospective analysis was performed on 226 patients with ischemic cardiomyopathy who underwent CABG and a preoperative left ventricular ejection fraction(LVEF)between 30%and 40%in Qingdao Municipal Hospital from March 2015 to March 2019.During the follow-up to 6 months after surgery,the recovery of LVEF was observed.The increase of LVEF was≥10%in the recovery group,and the increase in LVEF was<10%in the recovery group.The clinical,laboratory,and echocardiographic factors that may cause differences were analyzed.Results Of the 226 patients,121(53.5%)had good left ventricular function recovery.Univariate analysis showed that the recovery of LVEF in patients with ischemic cardiomyopathy(30%≤LVEF≤40%)was related to myocardial infarction,preoperative angina pectoris attack,N-terminal pro-B-type natriuretie peptide(NT-proBNP)level,left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD)and left ventricular end diastolic volume(LVEDV).Multivariate analysis showed that increased LVEDD and non-angina pectoris were independent risk factors for poor LVEF recovery in patients with ischemic cardiomyopathy(30%≤LVEF≤40%)(OR=3.898,1.214,P<0.05).LVEDD≥60 mm was significantly associated with poor recovery(χ2=8.631,OR=2.214,95%CI=1.252-3.981,P=0.005).The sensitivity and specificity of LVEDD≥60 mm in predicting postoperative poor LVEF recovery in patients with ischemic cardiomyopathy(30%≤LVEF≤40%)were 74.6%and 47.5%,respectively.Conclusions The increased LVEDD and no angina pectoris were independent risk factors for poor LVEF recovery after CABG in patients with ischemic cardiomyopathy(30%≤LVEF≤40%).LVEDD≥60 mm can be used as a predictor of less benefit from preoperative ejection function.