入院时心率联合左心室射血分数对老年心力衰竭患者预后的评估价值

The estimated value of heart rate at admission combined with left ventricular ejection fraction in prognosis of elderly patients with heart failure

目的探讨入院后静息心率(RHR)联合左心室射血分数(LVEF)与老年心力衰竭(HF)患者预后的相关性。方法选取2013年9月至2016年5月邢台市第三医院心内科收治年龄≥60岁的HF患者128例,根据患者3年随访期间是否发生不良心血管事件(MACE)分为MACE组72例和非MACE组56例,收集患者一般临床资料及入院后血液生化指标、LVEF及RHR,Cox比例风险模型分析LVEF及RHR与MACE的关系,并根据ROC曲线下LVEF及RHR的最佳临界值对HF患者进行危险分组,经Kaplan-Meier生存分析法分析各组间MACE平均发生时间的差异。结果与非MACE组比较,MACE组患者年龄、吸烟史比例、糖尿病及高血压病比例、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、RHR更高,而LVEF更低,差异均具有统计学意义(t/χ^(2)=9.396、4.688、6.080、9.000、2.566、41.571、9.043、19.601,P<0.05)。RHR、LVEF的ROC曲线下面积分别为0.858、0.782,最佳临界值分别为89次/min、45.18%;经校正传统危险因素后,Cox多因素分析结果显示RHR>89次/min、LVEF<45.18%是HF患者发生MACE的独立危险因素(HR=1.258、0.628,P<0.01);以RHR临界值89次/min和LVEF最佳截断值45.18%对HF患者进行危险分组:RHR≤89次/min和LVEF≥45.18%为低危组(36例),RHR>89次/min或者LVEF<45.18%为中危组(42例),RHR>89次/min和LVEF<45.18%为高危组(50例),各组患者发生MACE的Kaplan-Meier生存曲线显示,三组存在统计学意义(χ^(2)=15.398,P<0.01),其中高危组MACE平均发生时间明显小于低危组和中危组(χ^(2)=20.394、2.398,P<0.01)。结论RHR、LVEF是HF患者发生MACE的独立预测因子,二者联用可提高HF患者3年MACE发生的预测效率。

Objective To explore the correlation between resting heart rate(RHR)after admission combined with left ventricular ejection fraction(LVEF)and prognosis of elderly patients with heart failure(HF).Methods A total of 128 HF patients aged≥60 years old admitted to the department of cardiology of Xingtai third hospital from September 2013 to May 2016 were selected.According to the occurrence of major adverse cardiovascular events(MACE)during 3-year follow-up,patients were divided into MACE group(72 cases)and non-MACE group(56 cases).General clinical data and blood biochemical indicators,LVEF and RHR after admission were collected.Cox proportional hazard model analyzed the relationship between LVEF,RHR and MACE.According to the optimal threshold of LVEF and RHR under ROC curve,HF patients were divided into groups,and the differences of mean occurrence time of the MACE between groups were analyzed by Kaplan Meier survival.Results Compared with non-MACE group,age,smoking history,the proportions of diabetes mellitus and hypertension,triglycerides(TG),low density lipoprotein cholesterol(LDL-C)and RHR were higher in MACE group,while LVEF was lower(t/χ^(2)=9.396,4.688,6.080,9.000,2.566,41.571,9.043,19.601;P<0.05).The area under ROC curve of RHR and LVEF was 0.858 and 0.782 respectively,and the optimal threshold was 89 bpm and 45.18%respectively.After adjusting the traditional risk factors,Cox multivariate analysis results showed that RHR>89 beats per minute(bpm)and LVEF<45.18%were independent risk factors of MACE in HF patients(HR=1.258,0.628;P<0.01).Patients with HF were divided into groups with RHR threshold of 89 bpm and the optimal cutoff value of LVEF of 45.18%:RHR≤89 bpm and LVEF≥45.18%were low-risk group(n=36),RHR>89 bpm or LVEF<45.18%were medium risk group(n=42),RHR>89 bpm and LVEF<45.18%were high-risk group(n=50).The Kaplan Meier survival curve of MACE in each group showed that there was statistically significant difference in the three groups(χ^(2)=15.398,P<0.01),and the mean occurrence time of MACE in the high-risk group was significantly lower than that in the low-risk group and the middle-risk group(χ^(2)=20.394,2.398;P<0.01).Conclusion RHR and LVEF are independent predictors of MACE in HF patients.The combination of RHR and LVEF can improve the predictive efficiency of 3-year MACE in HF patients.