扩张型心肌病合并肺动脉高压的预测因素研究

Study on predictors of dilated cardiomyopathy with pulmonary arterial hypertension

目的对扩张型心肌病(dilated cardiomyopathy, DCM)合并肺动脉高压(pulmonary arterial hypertension, PAH)患者与未合并PAH的患者进行临床对比,探讨DCM患者发生PAH的预测因素。方法入选2014年12月—2017年12月在山东大学齐鲁医院就诊的DCM患者164例,随访至少12个月或至全因死亡。在随访过程中,将肺动脉收缩压(pulmonary artery systolic pressure, PASP)≥40 mm Hg并伴有右心室扩张者定义为DCM伴PAH。根据是否出现PAH将患者分为2组,对比2组患者的临床、心电图、胸部X线片、超声心动图等指标,采用多变量Logistic回归分析方法分析PAH的预测因素。结果 164例DCM患者中位数随访时间为30个月(12~52个月),55例(33.54%)患者出现PAH(DCM-PAH组)。出现PAH的患者平均PASP由基线的(30.31±8.37)mm Hg增加到(46.57±6.07)mm Hg(P<0.01),平均提高了(16.26±5.92)mm Hg。在109例未出现PAH(DCM组)的患者中,平均PASP由基线的(26.98±6.30)mm Hg增加到(37.12±5.09)mm Hg(P<0.01),平均提高了(10.14±4.16)mm Hg。多变量Logistic回归分析结果显示,心衰病史(OR=1.94,95%CI:1.50~2.92,P<0.05)、心电图QRS波时限(OR=1.15,95%CI:1.03~1.72,P<0.01)、左心房内径(left atrial diameter, LAD)(OR=1.27,95%CI:1.15~3.80,P<0.01)、PASP(OR=1.58,95%CI:1.45~2.89,P<0.05)是DCM出现PAH的预测因素。结论部分DCM患者随着疾病发展会出现PAH,心衰病史长,心电图QRS波时限延长,基线LAD扩大、PASP较高的DCM患者发生PAH的危险性高。

Objective The clinical data of dilated cardiomyopathy(DCM) patients with pulmonary arterial hypertension(PAH) and the ones without PAH was compared, to explore the predictors of DCM with PAH.Methods From Dec.2014 to Dec.2017,164 DCM patients in Qilu Hospital of Shandong University were reviewed and followed up for at least 12 months or to death.During follow-up, DCM with PAH is defined as pulmonary artery systolic pressure(PASP) ≥ 40 mm Hg with right ventricular dilation.After that patients were divided into two groups according to the presence of PAH.The clinical, ECG,chest X-ray and echocardiography indexes of the two groups were compared.The predictors were analyzed by multivariable logistic regression analysis.Results After a median follow-up of 30 months(12-52 months),PASP in 55 patients(DCM-PAH group) increased from(30.31±8.37) mm Hg to(46.57±6.07)mm Hg(P<0.01),and increased by an average of(16.26±5.92)mm Hg.PASP in 109 patients(DCM group) increased from(26.98±6.30)mm Hg to(37.12±5.09)mm Hg(P<0.01),and increased by an average of(10.14±4.16) mm Hg.Multivariable logistic regression analysis showed that symptom duration of heart failure(OR=1.94,95%CI:1.50-2.92,P<0.05),QRS duration(OR=1.15,95%CI:1.03-1.72,P<0.01),left atrial diameter(LAD)(OR=1.27,95%CI:1.15-3.80,P<0.01),PASP(OR=1.58,95%CI:1.45-2.89,P<0.05)at admission were independent predictors of DCM-PAH.Conclusion PAH would appear in some DCM patients as the disease progresses, especially for those with longer symptom duration of heart failure, longer QRS duration, larger LAD and higher PASP.