静息心率预测结缔组织疾病相关肺动脉高压患者远期预后的价值

Value of resting heart rate in predicting long-term prognosis in patients with connective tissue disease-associated pulmonary arterial hypertension

目的:探索静息状态下测得心率对结缔组织疾病相关肺动脉高压(connective tissue disease-associated pulmonary arterial hypertension,CTD-PAH)患者远期预后的预测作用。方法:收集2009—2021年南京医科大学第一附属医院风湿免疫科收治的所有经右心导管确诊的CTD-PAH患者89例。比较心率<100次/min和心率≥100次/min患者的临床特点、二维超声心动图参数、血流动力学参数及生存情况。采用Kaplan-Meier、Cox方法进行生存分析。结果:两组患者性别、年龄、WHO心功能分级、6 min步行距离、末端脑钠肽前体、二维超声心动图及血流动力学参数的差异均无统计学意义(P>0.05)。与静息心率<100次/min的CTD-PAH患者相比,静息心率≥100次/min的患者病死率更高(P<0.01)。静息心率<100次/min和≥100次/min的患者1年、3年及5年的总体生存率分别为98.6%、90.7%、87.6%和93.8%、66.8%、55.6%。校正年龄和性别后静息心率≥100次/min仍是CTD-PAH预后的独立危险因素。结论:静息心率可能是预测CTD-PAH患者远期不良预后的指标之一,可反映右心室整体功能情况。

Objective:To explore the relationship between resting heart rate and long-term prognosis of patients with connective tissue disease-associated pulmonary arterial hypertension(CTD-PAH).Methods:A total of 89 patients with CTD-PAH diagnosed by right cardiac catheterization were collected from the Departments of Rheumatology,the First Affiliated Hospital of Nanjing Medical University from 2009 to 2021.The clinical characteristics,two-dimensional echocardiographic parameters,hemodynamic parameters and survival of patients with heart rate<100 beats/min and heart rate≥100 beats/min were compared.Kaplan-Meier and Cox methods were used for survival analysis.Results:There was no significant difference in sex,age,WHO functional class,6-minute walking distance,N-terminal pro-brain natriuretic peptide,two-dimensional echocardiographic and hemodynamic parameters between the two groups.The mortality of patients with resting heart rate≥100 beats/min was higher than that of patients with resting heart rate<100beats/min(P<0.01).The overall 1-,3-and 5-year survival rates of patients with resting heart rate<100 beats/min and≥100 beats/min were 98.6%,90.7%,87.6%and 93.8%,66.8%,55.6%.After adjustment for age and sex,resting heart rate≥100 beats/min remained an independent risk factor for prognosis of patients with CTD-PAH.Conclusion:The resting heart rate may be one of the indexes to predict the long-term poor prognosis of patients with CTD-PAH and may reflect the overall function of the right ventricle.