射血分数降低的心力衰竭患者高肺血管阻力的临床特征和危险因素分析

Clinical Characteristics and Risk Factors of Elevated Pulmonary Vascular Resistance in Patients With Heart Failure With Reduced Ejection Fraction

目的:分析射血分数降低的心力衰竭(HFrEF)患者高肺血管阻力(PVR)的临床特征和危险因素。方法:连续纳入2017年1月至2019年12月在我中心行右心导管检查的HFrEF患者共164例,收集患者的临床和右心导管检查数据。右心导管检查测得PVR≥5.0 Wood单位(WU)定义为PVR显著升高。采用Lasso-Logistic回归分析法进行数据降维与特征选择,并评估PVR显著升高患者的临床危险因素。结果:右心导管检查结果显示,164例HFrEF患者中,107例(65.2%)患者PVR显著升高。Lasso-Logistic回归分析显示,收缩压下降(OR=1.04,95%CI:1.02~1.06)、左心室射血分数降低(OR=1.16,95%CI:1.06~1.27)、血钾降低(OR=2.55,95%CI:1.02~6.36)、左心房内径增大(OR=1.09,95%CI:1.02~1.16)、合并冠心病(OR=4.97,95%CI:1.39~18.02)、未使用β受体阻滞剂(OR=6.80,95%CI:1.83~25.22)是HFrEF患者PVR显著升高的临床危险因素(P均<0.05)。结论:本研究中HFrEF患者PVR显著升高的发生率为65.2%。PVR显著升高的临床危险因素包括收缩压下降、左心室射血分数降低、血钾降低、左心房内径增大、合并冠心病、未使用β受体阻滞剂。

Objectives:To analyze the clinical characteristics and risk factors of significantly elevated pulmonary vascular resistance(PVR)in patients with heart failure with reduced ejection fraction(HFrEF).Methods:The present study enrolled 164 consecutive patients with HFrEF who received right heart catheterization(RHC)in our center.Significantly elevated PVR was defined as great than or equal to 5.0 Wood units(WU).Data of clinical characteristics and RHC results were collected and analyzed.We conducted Lasso-Logistic regression for dimension reduction and feature selection,and then identified risk factors for significantly elevated PVR in HFrEF patients.Results:Significantly elevated PVR was diagnosed by RHC in 107 out of 164 patients(65.2%)with HFrEF.The Lasso-Logistic regression revealed that decreased systolic blood pressure(OR=1.04,95%CI:1.02-1.06),reduced left ventricular ejection fraction(OR=1.16,95%CI:1.06-1.27),lower serum potassium(OR=2.55,95%CI:1.02-6.36),enlarged left atrial dimension(OR=1.09,95%CI:1.02-1.16),comorbidity with coronary heart disease(OR=4.97,95%CI:1.39-18.02)and absence of beta-blockers treatment(OR=6.80,95%CI:1.83-25.22)were the risk factors of significantly elevated PVR in patients with HFrEF(all P<0.05).Conclusions:The incidence of significantly elevated PVR is 65.2%in this cohort.Risk factors of significantly elevated PVR in HFrEF include decreased systolic blood pressure,reduced left ventricular ejection fraction,lower serum potassium,enlarged left atrial diameter,comorbidity with coronary heart disease and absence of beta-blockers treatment.