心力衰竭患者不良预后的危险因素分析

Analysis of clinical factors related to poor prognosis in patients with heart failure

目的比较不同左室射血分数(LVEF)心力衰竭患者的预后,探讨心力衰竭患者不良预后的相关临床因素。方法纳入2009年1月至2017年12月因心力衰竭住院并随访的患者,分为射血分数减低的心力衰竭组(HFrEF,LVEF<40%)、射血分数中间值心力衰竭组(HFmrEF,40%≤LVEF<50%)、射血分数保留的心力衰竭组(HFpEF,LVEF≥50%)。收集临床资料,记录终点事件。结果共纳入患者517例,其中HFrEF组172例,HFmrEF组80例,HFpEF组265例。随访28.7(14.4,60.3)月,发生全因死亡181例,心血管死亡120例,猝死18例。Kaplan-Meier生存分析显示各组心血管死亡率差异有统计学意义(P=0.016),HFrEF组(P=0.006)和HFmrEF组(P=0.047)心血管死亡率高于HFpEF组。增龄、体质指数降低、反复心力衰竭住院、血红蛋白降低、肾小球滤过率降低、N末端B型利钠肽原升高、卒中或一过性脑缺血发作史、合并慢性阻塞性肺疾病、左房内径>45 mm、LVEF<35%、肺动脉高压是不良预后的独立危险因素。结论不同LVEF患者预后存在差异,多个独立危险因素提示预后不良。

Objective To compare the prognosis of patients with heart failure(HF)with different left ventricular ejection fraction(LVEF),and to explore the related clinical factors for poor prognosis in HF patients.Methods Patients hospitalized and followed up in our hospital for HF from January 2009 to December 2017 were included.They were divided into 3 groups:heart failure with reduced ejection fraction(HFrEF,LVEF<40%),heart failure with mid-range ejection fraction(HFmrEF,40%≤LVEF<50%),heart failure with preserved ejection fraction(HFpEF,LVEF≥50%).Clinical data were collected,end-point events were recorded.Results A total of 517 patients were included,172 patients with HFrEF,80 patients with HFmrEF,265 patients with HFpEF.In the follow-up period of 28.7(14.4,60.3)months,181 cases of all-cause death,120 cases of cardiovascular death and 18 cases of sudden death occurred.Kaplan-meier survival analysis showed there were statistically significant differences in cardiovascular mortality among the groups(P=0.016),cardiovascular mortality in HFrEF group(P=0.006)and HFmrEF group(P=0.047)was higher than that in HFpEFgroup.Aging,decreased body mass index,repeated hospitalization for HF,decreased hemoglobin,decreased glomerular filtration rate,increased NT-proBNP,history of stroke or transient ischemic attack,COPD,left atrial diameter>45mm,LVEF<35%,and pulmonary hypertension were independent risk factors for poor prognosis in patients with HF.Conclusions The prognosis of HF patients with different LVEF is different,and multiple independent risk factors suggest poor prognosis in HF patients.