左心房前后径对心力衰竭住院患者预后的预测价值

Predictive value of left atrial anteroposterior diameter on outcome of patients hospitalized with heart failure

目的探讨左心房前后径(LAD-ap)对心力衰竭(心衰)住院患者预后的预测价值。方法回顾性入选2009年1月1日至2017年12月31日因心衰在北京医院住院并有随访记录的患者,根据超声心动图测量的LAD-ap中位数将患者分为LAD-ap较大组和LAD-ap较小组,收集其临床资料,记录终点事件,包括全因死亡(ACD)和心血管原因死亡(CVD)。结果本研究共纳入心衰患者558例,年龄(74±12)岁,女性220例(39.4%)。LAD-ap中位数为44 mm,其中,LAD-ap>44 mm组265例(47.5%),LAD-ap≤44 mm组293例(52.5%)。与LAD-ap≤44 mm组比较,LAD-ap>44 mm组体质量指数较大,收缩压较低,纽约心脏协会(NYHA)心功能Ⅲ~Ⅳ级的患者较多;新发心衰和冠心病比例较低,心房颤动比例较高;左心室舒张末期内径较大,肺动脉高压比例较高,节段性室壁运动异常比例较低;N末端B型利钠肽原(NT-proBNP)较高。随访28(14,60)月,203例(36.4%)患者发生ACD,131例(23.5%)患者发生CVD。LAD-ap>44 mm组ACD(44.2%比29.4%,log-rank P<0.001)和CVD(29.4%比18.1%,log-rank P=0.002)的发生率均高于LAD-ap≤44 mm组。多因素Cox回归分析结果显示,在校正其他协变量后,LAD-ap仍是ACD(调整的风险比HR=1.035,95%可信区间CI 1.013~1.056,P=0.001)和CVD(HR=1.043,95%CI 1.017~1.069,P=0.001)的独立危险因素。结论LAD-ap是心衰住院患者ACD和CVD的独立预测因素之一,有助于这些患者的危险分层。

Objective To investigate the predictive value of left atrial anteroposterior diameter(LAD-ap)on the prognosis of patients hospitalized with heart failure(HF).Methods Patients hospitalized with HF in Beijing Hospital between January 1,2009 and December 31,2017 with follow-up records were retrospectively enrolled.According to the median of LAD-ap detected by echocardiography,the patients were classified as group with larger LAD-ap and group with smaller LAD-ap.Clinical data were collected and endpoint events(all-cause death and cardiovascular death)were recorded.Results A total of 558 patients were included in the analysis with the age of(74±12)years,including 220(39.4%)females.The median LAD-ap was 44 mm.There were 265 cases(47.5%)with LAD-ap>44 mm and other 293 cases(52.5%)with LAD-ap≤44 mm.Patients with LAD-ap>44 mm have higher body mass index,lower systolic blood pressure,higher frequency of New York Heart Association(NYHA)functional classⅢorⅣ,lower frequency of new-onset HF and coronary heart disease,higher left ventricular end-diastolic diameter,higher frequency of pulmonary hypertension,lower frequency of segmental wall motion abnormalities(SWMA),and higher N terminal-pro B type natriuretic peptide(NT-proBNP)than those with LAD-ap≤44 mm.There were 203 cases(36.4%)showing all-cause deaths(ACD)and 131(23.5%)showing cardiovascular deaths(CVD)during a followu-up of 28(14,60)months.Rate of ACD(44.2%vs.29.4%,log-rank P<0.001)and CVD(29.4%vs.18.1%,log-rank P=0.002)were significantly higher in patients with larger LAD-ap.Multivariate Cox proportional regression analysis showed that after adjusting other covariates,LAD-ap was an independent risk factor for ACD[adjusted hazard ratio(HR)1.035,95%confidence interval(CI)1.013-1.056,P=0.001)]and CVD(HR 1.043,95%CI 1.017-1.069,P=0.001).Conclusions LAD-ap was an independent predictor of ACD and CVD for patients hospitalized with HF,which may be helpful for risk stratification in these patients.