心脏电-机械活动时间比值对慢性心力衰竭患者发生院外不良事件的预测价值

The predictive value of cardiac electro-mechanical activation time ratio for out-hospital adverse events in patients with chronic heart failure

目的评价心脏电-机械活动时间比值(EMAT%)对慢性心力衰竭(CHF)患者发生院外不良事件的预测价值。方法选取2015年8月至2018年8月于首都医科大学附属北京安贞医院心内科监护室治疗并好转出院的120例CHF患者。记录患者基线资料和出院前心室率、B型脑钠肽(BNP)、肌钙蛋白I、血肌酐、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、EMAT%水平。分析患者发生院外不良心脏事件(心源性死亡、全因死亡、因心力衰竭再住院)的危险因素。结果随访时间616(203,875)d,截至随访结束,120例患者中存活95例,其中因心力衰竭再住院23例;全因死亡25例,其中心源性死亡14例。心源性死亡患者EMAT%>15%比例高于未发生心源性死亡患者[57.1%(8/14)比27.4%(29/106)],差异有统计学意义(P<0.05)。全因死亡患者年龄、既往血运重建比例、BNP水平均高于存活患者,差异均有统计学意义(均P<0.05)。因心力衰竭再住院患者年龄、慢性肾功能衰竭比例、BNP水平均高于未因心力衰竭再住院患者,差异均有统计学意义(均P<0.05)。Cox回归分析结果显示EMAT%>15%[风险比=3.493(95%置信区间:1.021~11.947)]是CHF患者院外发生心源性死亡的独立危险因素,BNP>400 ng/L是全因死亡及因心力衰竭再住院的独立危险因素(均P<0.05)。Kaplan-Meier生存曲线结果显示,EMAT%>15%的CHF患者院外心源性死亡风险较高(Log-rank χ^(2)=5.450,P=0.020)。结论EMAT%>15%可能是CHF患者院外发生心源性死亡的独立危险因素,可作为BNP的补充指标。

Objective To evaluate the predictive value of cardiac electro-mechanical activation time ratio(EMAT%)for out-hospital adverse events in patients with chronic heart failure(CHF).Methods From August2015 to August 2018,120 cases with CHF admitted to Intensive Care Unit of Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University and discharged after improvement were enrolled.The baseline data,levels of ventricular rate,brain natriuretic peptide(BNP),troponin I,serum creatinine,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),and EMAT%before discharge were collected.The risk factors of out-hospital cardiac adverse events(cardiac death,all-cause death,rehospitalization for heart failure)in patients with CHF were analyzed.Results The followed-up time was 616(203,875)d.Up to the end of follow-up among 120 cases,there were 95 cases surviving,and 23 of who rehospitalized for heart failure;there were 25 cases died of all-cause,and 14 of who died of cardiac reasons.The rate of EMAT%>15%in cardiac death patients was higher than that in non cardiac death patients[57.1%(8/14)vs 27.4%(29/106)](P<0.05).The age,previous revascularization rate and BNP level in all-cause death patients were higher than those in surviving patients(all P<0.05).The age,chronic renal failure rate,and BNP level in patients rehospitalized for heart failure were higher than those in patients not rehospitalized for heart failure(all P<0.05).Cox regression analysis identified that EMAT%>15%[hazards ratio=3.493(95%confidence interval:1.021-11.947)]was an independent risk factor for cardiac death in patients with CHF,and BNP>400 ng/L was an independent risk factor for all-cause death and rehospitalization for heart failure in patients with CHF(all P<0.05).Kaplan-Meier survival curve showed that CHF patients with EMAT%>15%had high risk of cardiac death in patients with CHF(Log-rank χ^(2)=5.450,P=0.020).Conclusion EMAT%>15%may be an independent risk factor of cardiac death in patients with CHF,and it can be used as a supplementary index of BNP.