左心室球形指数对扩张型心肌病预后预测价值的研究

The value of left ventricular spherical index in predicting the prognosis of dilated cardiomyopathy

目的探讨左心室球形指数(LVSI)对扩张型心肌病(DCM)患者预后的预测价值。方法收集就诊DCM患者,给予标准抗心力衰竭药物治疗并随访6个月,根据是否发生主要心血管不良事件(MACE)分为预后良好组(n=77)和预后不良组(n=154)。收集所有患者年龄、病程、体质量指数(BMI)、入院血压、N末端B型钠尿肽前体(NT-proBNP)、超声心动图指标等临床资料,记录随访期间药物服用情况、MACE的发生情况。应用二项分类logistic回归分析DCM患者发生MACE的危险因素,运用受试者工作特征(ROC)曲线分析LVSI对DCM患者发生MACE的预测价值。结果与预后良好组相比,预后不良组的患者病程更长,心率更快,NT-proBNP、左心房内径(LAD),左心室收缩末内径(LVEDd),LVSI均增加;入院收缩压(SBP)、左心室射血分数(LVEF)减小(P<0.001),其余指标差异无统计学意义。二项分类logistic回归分析结果表明,心衰病程(OR=1.187,95%CI:1.091~1.290,P<0.001)、入院SBP(OR=2.089,95%CI:1.243~3.510,P=0.005)、LVEDd(OR=1.241,95%CI:1.080~1.426,P=0.002)、LVEF(OR=0.862,95%CI:0.771~0.963,P=0.009)、LVSI(OR=1.462,95%CI:1.262~1.693,P<0.001)、NT-proBNP(OR=1.001,95%CI:1.000~1.001,P=0.002)是DCM患者是否发生MACE的独立预测因素。LVSI为61.95%,是预测MACE发生的最佳临界值,此时ROC曲线下面积为0.821(95%CI:0.769~0.874,P<0.001),约登指数最大为0.461,敏感性为0.695,特异性为0.766。结论LVSI、LVEDd、LVEF、心衰病程、入院SBP、NT-proBNP是DCM患者预后的影响因素。LVSI对于DCM患者的预后具有一定的预测作用。

Objective To explore the predictive value of left ventricular spherical index(LVSI)in prognosis of patients with dilated cardiomyopathy(DCM).Methods The DCM patients from hospital were included.All DCM patients were treated with standard anti-heart failure drugs and followed up for six months.They were divided into a good prognosis group according to whether adverse cardiovascular events(MACE)occurred(n=77)and poor prognosis group(n=154).All patients′age,course of disease,body mass index(BMI),blood pressure,N-terminal fragment of the BNP precursor(NT-proBNP),echocardiogram indicators and other clinical data were collected,and the drug consumption during the follow-up period and the occurrence of MACE events were recorded.Binomial logistic regression was used to analyze the risk factors of MACE events in DCM patients,and receiver operating characteristic(ROC)curves were used to analyze the predictive value of LVSI for MACE events in DCM patients.Results Compared with the good prognosis group,the patients in the poor prognosis group had a longer course of disease,faster heart rate,and increased NT-proBNP,left atrium diameter(LAD),left ventricular end diastolic diameter(LVEDd),and LVSI;systolic blood pressure and left ventricular ejection fraction(LVEF)decreased(P<0.001),and other indicators had no statistical difference.The results of binomial logistic regression analysis showed that the duration of heart failure(OR=1.187,95%CI:1.091-1.290,P<0.001),admission systolic blood pressure(OR=2.089,95%CI:1.243-3.510,P=0.005),LVEDd(OR=1.241,95%CI:1.080-1.426,P=0.002),LVEF(OR=0.862,95%CI:0.771-0.963,P=0.009),LVSI(OR=1.462,95%CI:1.262-1.693,P<0.001),NT-proBNP(OR=1.001,95%CI:1.000-1.001,P=0.002)were independent predictors of MACE in DCM patients.LVSI of 61.95%was the best critical value for predicting the occurrence of MACE.At this time,the area under the ROC curve was 0.821(95%CI:0.769-0.874,P<0.001),the maximum Youden index was 0.461,and the sensitivity:0.695,specificity:0.766.Conclusion LVSI,LVEDd,LVEF,heart failure course,admission systolic blood pressure,NT-proBNP are the prognostic factors of DCM patients.The left ventricular spherical index has a certain predictive effect on the prognosis of DCM patients.