体位性低血压对老年心力衰竭患者长期预后的影响

Effect of orthostatic hypotention on long-term prognosis of elderly patients with heart failure

目的探讨体位性低血压(OH)对老年心力衰竭(HF)患者长期不良心脑血管事件(MACCE)的影响,并分析影响MACCE的危险因素。方法回顾性队列研究,连续纳入2015年1月至2018年1月在我院诊治的老年HF患者。依据是否合并OH,选择100例合并OH的HF患者为OH组,并按照1∶2比例选择年龄和左室射血分数匹配的、未合并OH的200例HF患者为对照组。随访截止到2019年12月,记录MACCE发生情况,包括全因死亡、因HF再入院、急性心肌梗死、卒中和恶性心律失常。应用Kaplan-Meier生存分析和Log-rank检验分析两组的MACCE发生情况。应用单因素和多因素Cox比例风险回归模型分析影响MACCE的危险因素。结果300例老年HF患者中,男性160例(53.3%),平均年龄(72.3±12.1)岁。与对照组相比,OH组患者较多合并高血压(57.8%比40.5%)和糖尿病(38.0%比25.5%),空腹血糖、立位收缩压和舒张压、卧位收缩压和舒张压水平均较高,但应用利尿剂比例较低(83.0%比93.5%)(均为P<0.05)。平均随访(28.3±15.4)个月,失访29例(9.7%)。随访期间,共有107例(35.7%)患者发生MACE,包括12例(4.0%)死亡、50例(16.7%)因HF再入院、18例(6.0%)急性心肌梗死和10例(3.3%)卒中。Kaplan-Meier生存分析和Log-rank检验结果提示,OH组患者的因HF再入院(27.0%比11.5%,P=0.001)、卒中(6.0%比2.0%,P=0.037)和MACCE发生率(53.0%比27.0%,P<0.001)均显著高于对照组。多因素Cox比例风险回归模型结果显示,OH是老年HF患者发生MACCE的独立危险因素(HR=1.779,95%CI:1.165~2.717,P=0.008)。结论OH可显著增加老年HF患者的再入院率和卒中发生风险,且为MACCE的独立危险因素。

Objective To explore the impact of orthostatic hypotension(OH)on long-term adverse cardiovascular and cerebrovascular events(MACCE)in elderly patients with heart failure(HF),and analyze the risk factors that affect MACCE.Methods This study is a retrospective cohort study.Elderly HF patients who were diagnosed and treated in our hospital from January 2015 to January 2018 were continuously enrolled.According to whether or not combined with OH,a total of 100 of HF patients with OH were selected as the OH group,and 200 patients with similar age and left ventricular ejection fraction without OH were selected as the control group.The deadline follow-up date was December 31,2019.The rates of MACCE,including all-cause deaths,readmissions due to HF,acute myocardial infarction,stroke,and malignant arrhythmia were recorded.Kaplan-Meier survival analysis and Log-rank test were used to analyze the occurrence of MACCE in the two groups.Univariate and multivariate Cox proportional hazards regression models were used to analyze the risk factors that affect MACCE.Results Among 300 elderly patients with HF,160(53.3%)were male,with an average age of(72.3±12.1)years.Compared with the control group,patients in the OH group were complicated with higher rates of hypertension(57.8%vs.40.5%)and diabetes(38.0%vs.25.5%).Meanwhile,the levels of fasting blood glucose,vertical systolic and diastolic blood pressure,supine systolic and diastolic blood pressure were significantly higher,but the proportion of diuretics used was lower(83.0%vs.93.5%)in the OH group(all P<0.05).The average follow-up was(28.3±15.4)months,and 29 cases(9.7%)were lost to follow-up.During the follow-up period,a total of 107(35.7%)patients had MACE,including 12 deaths from all causes(4.0%),50 re-admissions due to HF(16.7%),18 acute myocardial infarction(6.0%),and 10 strokes(3.3%).Kaplan-Meier survival analysis and Log-rank test showed that patients in the OH group were associated with higher rates of readmitted to hospital due to HF(27.0%vs.11.5%,P=0.001),stroke(6.0%vs.2.0%,P=0.037)and MACCE(53.0%vs.27.0%,P<0.001),but the rates of all-cause mortality(5.0%vs.3.5%,P=0.532),acute myocardial infarction(8.0%vs.5.0%,P=0.302)and malignant arrhythmia(7.0%vs.5.0%,P=0.480)were similar between the two groups.The multivariate Cox proportional hazards regression model showed that OH is an independent risk factor for MACCE in elderly HF patients(HR=1.779,95%CI:1.165-2.717,P=0.008).Conclusions OH can significantly increase the rates of HF readmission and stroke in elderly HF patients,and it is an independent risk factor for MACCE.