体重指数对射血分数保留性心力衰竭患者右心结构的影响

The Effect of Body Mass Index on Right Heart Structure of Heart Failure Patients with Preserved Ejection Fraction

目的探讨体重指数(BMI)对射血分数保留性心力衰竭(HFpEF)患者右心结构的影响。方法选取2015年1月—2019年12月兰州大学第一医院老年心血管科收住的新诊断的HFpEF患者289例,根据BMI的不同分为体重正常组(18.5 kg·m^(-2)≤BMI<24 kg·m^(-2))131例和超重肥胖组(BMI≥24 kg·m^(-2))158例。采用超声心动图测定右心结构并比较其变化。结果超重肥胖组右心室游离壁厚度[舒张末期(RV-FWd)、收缩末期(RV-FWs)]较体重正常组增厚,差异有统计学意义(P<0.05);超重肥胖组右心室基底部内径(RV-D1)、右心室中部内径(RV-D2)、右心室流出道内径[主动脉瓣上(RVOT1)、肺动脉瓣环水平(RVOT2)]、右心房长轴内径(RA-D2)和肺动脉内径(PA)较体重正常组增宽,差异有统计学意义(P<0.05);右心室长轴内径(RV-D3)、右心房短轴内径(RA-D1)较体重正常组增宽,但差异无统计学意义(P>0.05);超重肥胖组肺动脉收缩压(PASP)较体重正常组升高,差异无统计学意义(P>0.05)。相关性分析显示BMI与RV-FWd、RV-FWs、RV-D1、RV-D2、RVOT1、RVOT2、RA-D2、右心房面积和PA等右心结构指标呈正相关。多元线性回归分析BMI与RV-FWd、RV-FWs、RVOT1、RVOT2、RA-D2和PA独立相关,阻塞性睡眠呼吸暂停低通气综合征与PA独立相关,慢性阻塞性肺疾病与RV-FWd、RV-FWs、RV-D2、RV-D3、RVOT1、RVOT2、RA-D1、PA和PASP独立相关,心房颤动与RV-D1、RV-D2、RA-D1、RA-D2和右心房面积独立相关,糖尿病与RV-FWd、RV-FWs、RV-D1、RA-D1和RAA独立相关。结论BMI与HFpEF患者右心结构改变关系密切。

Objective To investigate the effect of body mass index(BMI)on the structure of right heart in patients of heart failure with preserved ejection fraction(HFpEF).Methods A total of 289 newly diagnosed HFpEF patients admitted to the Department of Geriatric Cardiology,The First Hospital of Lanzhou University from January 2015 to December 2019 were enrolled and divided into control group(n=131,18.5 kg·m^(-2)≤BMI<24 kg·m^(-2))and study group(n=158,BMI≥24 kg·m^(-2)).The structure of right heart was measured by echocardiography,then changes was compared.Results The thickness of right ventricular end diastolic free wall(RV-FWd)and right ventricular end systolic free wall(RV-FWs)were greater in study group than control group with a significant difference(P<0.05).The basal diameter of right ventricle(RV-D1),middle diameter of right ventricle(RV-D2),inner diameters of right ventricular outflow tract(RVOT1 above aortic valve,RVOT2 on pulmonary valve ring),long axis of right atrium(RA-D2)and pulmonary artery(PA)were wider in study group than control group(P<0.05).The differences on widened inner diameter of long axis of right ventricle(RV-D3),short axis of right atrium(RA-D1)and increased pulmonary artery pressure(PASP)between two groups were not significant.Correlation analysis showed BMI was positively correlated with RV-FWd,RV-FWs,RV-D1,RV-D2,RVOT1,RVOT2,RA-D2,RAA,PA and other indexes of right cardiac structure.Multiple linear regression analysis indicated BMI was independently correlated with RV-FWd,RV-FWs,RVOT1,RVOT2,RA-D2 and PA,exactly as obstructive sleep apnea hypopnea syndrome correlated with PA,chronic obstructive pulmonary disease correlated with RV-FWd,RV-FWs,RV-D2,RV-D3,RVOT1,RVOT2,RA-D1,PA,PASP,atrial fibrillation correlated with RV-D1,RV-D2,RA-D1,RA-D2,RAA,and diabetes mellitus correlated with RV-FWd,RV-FWs,RV-D1,RA-D1 and RAA.Conclusion BMI is closely related to the structural changes of right heart in HFpEF patients.