左心功能相关参数及左右心室内径比值与中重度肺动脉高压患者预后的关系

Relationship of Left Ventricular Functional Parameters and the Ratio of Left/Right Ventricular Diameters With the Prognosis of Patients With Moderate to Severe Pulmonary Hypertension

目的:探讨超声心动图无创测量左心功能相关参数及左右心室内径比值与中重度肺动脉高压患者预后的关系。方法:回顾性分析2019年1月至2020年11月我院心内科住院的中重度肺动脉高压患者90例,并依据随访中临床恶化[包括全因死亡、肺移植、因肺动脉高压恶化再住院、肺动脉高压治疗升级(增加口服靶向药物种类或增加剂量或增加皮下或静脉注射靶向药物)]情况,分为临床恶化组与无临床恶化组。采用单因素和多因素Cox比例风险回归模型、Kaplan-Meier生存曲线分析超声心动图测量左心功能相关参数及左右心室内径比值与中重度肺动脉高压患者预后的关系。结果:中位随访12.1(9.1,14.3)个月期间,86例(95.6%)患者完成随访,34例发生临床恶化。与无临床恶化组(n=52)相比,临床恶化组(n=34)左心输出量_(超声心动图)(CO_(Echo))、左心指数_(超声心动图)(CI_(Echo))、左心室舒张末期内径/右心室流出道近端内径比值(LVEDd/RVOT-prox)更低,右心室/左心室基底段左右径比值(RVTDd/LVTDd)更高,6分钟步行距离(6MWD)更短,差异均有统计学意义(P均<0.05)。多因素Cox回归分析表明,CI_(Echo)及LVEDd/RVOT-prox是预测中重度肺动脉高压患者预后的独立危险因素(P=0.027、P=0.021)。Kaplan-Meier生存曲线表明,CI_(Echo)<2.710 L/(min·m^(2))及LVEDd/RVOT-prox<1.064的患者临床恶化发生率显著升高(P均=0.001)。结论:超声心动图测量左心功能参数CI_(Echo)及LVEDd/RVOT-prox可以良好预测中重度肺动脉高压患者的临床恶化发生率。

Objectives:To explore the relationship of left ventricular functional parameters and the ratio of left/right ventricular diameters with the prognosis of patients with moderate to severe pulmonary hypertension.Methods:This retrospective analysis included 90 patients with moderate to severe pulmonary hypertension who were hospitalized in the department of cardiology in our hospital from January 2019 to November 2020.According to the clinical worsening during follow-up,they were divided into clinical worsening group and non-clinical worsening group.Univariate and multivariate Cox proportional hazard regression models and Kaplan-Meier survival curves were used to analyze the relationship between echocardiography-derived variables and the prognosis of enrolled patients.Results:Eighty-six out of 90 enrolled patients with moderate to severe pulmonary hypertension completed the followup.During a median follow-up period of 12.1(9.1,14.3)months,clinical worsening event occurred in 34 cases.Compared with the non-clinical worsening group,patients in the clinical worsening group had lower left ventricular cardiac output(CO_(Echo)),left ventricular cardiac index(CI_(Echo)),left ventricular end diastolic diameter/proximal inner diameter of the right ventricular outflow tract(LVEDd/RVOT-prox),shorter the six-minute walking distance(6MWD)and higher end diastolic right ventricular/left ventricular basal segment transverse diameter ratio(RVTDd/LVTDd)(all P<0.05).Multivariate Cox regression analysis showed that CI_(Echo)and LVEDd/RVOT-prox were the independent risk factors for predicting the prognosis of patients with moderate to severe PH(P=0.027,P=0.021).Kaplan-Meier survival curve showed that the incidence of clinical worsening was significantly increased in patients with CI_(Echo)<2.710 L/(min·m^(2))(P=0.001)and LVEDd/RVOT-prox<1.064(P=0.001).Conclusions:Echocardiography derived ventricular functional and structural parameters CI_(Echo) and LVEDd/RVOT-prox can be used to predict the incidence of clinical worsening in patients with moderate to severe pulmonary hypertension.