缺血性心肌病与非缺血性心肌病的临床特征及预后对比分析

Clinical Characteristics and Prognosis of Ischemic and Non-ischemic Cardiomyopathy

目的分析缺血性心肌病(ICM)和非缺血性心肌病(NICM)的临床特征和预后影响因素。方法本研究纳入2016年1月至2017年12月在厦门大学附属心血管病医院住院的心力衰竭患者,根据心力衰竭病因分为ICM组和NICM组,对比两组患者的临床特征、预后情况,使用Kaplan-Meier法进行生存分析,并采用COX比例风险回归分别对两组患者全因死亡和心力衰竭再住院的影响因素进行分析。结果本研究纳入531例心力衰竭患者,剔除12例接受非药物干预及失访的患者,以及93例心力衰竭病因不明的患者,其余患者被分为ICM组(215例)和NICM(211例),平均随访(55.16±6.78)个月。随访期间,ICM组95例(44.19%)患者死亡,其中心脏性死亡65例(68.42%),心脏性猝死(SCD)46例(48.42%);NICM组患者死亡69例(32.70%),其中心脏性死亡47例(68.12%),SCD 31例(44.93%)。Kaplan-Meier生存分析提示ICM组的全因病死率高于NICM组(P<0.05),但两组的心力衰竭再住院无明显差异(P>0.05)。ICM全因死亡的独立危险因素包括既往心力衰竭住院、重度二尖瓣反流、低T3综合征和NT-proBNP。NICM全因死亡的独立危险因素包括既往心力衰竭住院、频发室性早搏、LVEF、重度二尖瓣反流、低T3综合征和NT-proBNP。ICM心力衰竭再住院的独立危险因素包括既往心力衰竭住院、频发室性早搏、左房内径、低T3综合征和NT-proBNP。NICM心力衰竭再住院的独立危险因素包括心力衰竭病程、非持续室速、左房内径、二尖瓣重度反流、左束支阻滞和NT-proBNP。结论ICM和NICM具有不同的临床特征、心力衰竭预后危险因素,与NICM相比,ICM组患者死亡风险更高。

Objective To analyze the clinical characteristics and prognostic factors of ischemic cardiomyopathy(ICM)and non-ischemic cardiomyopathy(NICM).Methods This study included patients with heart failure(HF)who were hospitalized in the Cardiovascular Hospital of Xiamen University from January 2016 to December 2017.The patients were divided into ICM and NICM group.The clinical characteristics and prognosis of the two groups were compared.Kaplan-Meier method was used for survival analysis.COX proportional hazards regression was used to analyze the risk factors of all-cause death and rehospitalization due to HF in the two groups.Results 531 patients with HF were enrolled in this study.Excluding 12 patients who received non-drug intervention and failed to be followed up,and 93 patients with unknown causes of HF,the rest were divided into ICM(215 cases)and NICM(211 cases)group,with an average follow-up of(55.16±6.78)months.During the follow-up,95(44.2%)in ICM group died,including 65(68.42%)cardiac death and 46(48.42%)sudden cardiac death(SCD);69(32.70%)in NICM group died,including 47(68.12%)cardiac death and 31(44.93%)SCD.Kaplan-Meier survival analysis showed that the all-cause mortality in ICM was higher than that in NICM(P<0.05),but there was no significant difference in rehospitalization due to HF between the two groups(P>0.05).Independent risk factors for all-cause death in ICM included previous hospitalization due to HF,severe mitral regurgitation,low T3 syndrome,and NT proBNP.Independent risk factors for all-cause death in NICM included previous hospitalization due to HF,frequent ventricular premature beats,left ventricular ejection fraction,severe mitral regurgitation,low T3 syndrome and NT proBNP.Independent risk factors for rehospitalization due to HF in ICM included previous hospitalization due to HF,frequent ventricular premature beats,left atrial diameter,low T3 syndrome and NT proBNP.Independent risk factors for heart failure readmission in NICM included heart failure duration,nonsustained ventricular tachycardia,left atrial diameter,severe mitral regurgitation,left bundle branch block,and NT-proBNP.Conclusion ICM and NICM have different clinical characteristics and risk factors affecting the prognosis,all-cause mortality in ICM is higher than that in NICM.