静息心率和红细胞比容对射血分数保留型及中间型老年心力衰竭患者易损期内心血管事件的影响

Influence of resting heart rate and erythrocyte volume fraction cardiovascular events in elderly patients with preserved or mid-range ejection fraction heart failure during the vulnerable phase

目的探讨射血分数保留型及中间型老年心力衰竭(心衰)患者易损期内发生主要心血管事件(MACE)的影响因素。方法回顾性收集2017年1月至2019年10月于天津医科大学总医院老年医学科住院治疗的射血分数保留型及中间型心力衰竭患者312例,失访17例,最终本研究共入选射血分数保留型及中间型老年心衰患者295例。按照易损期内(出院后90 d)是否发生MACE分为MACE组87例和非MACE组208例,比较两组患者的基线资料,进行单因素Logistics回归分析,确定发生MACE的危险因素,对患者随访结果行Cox回归分析和Kaplan-Meier生存分析,评价静息心率和红细胞比容对患者易损期内发生MACE的影响。使用受试者工作特征曲线(ROC)评估静息心率及红细胞比容对MACE的预测价值。结果MACE组患者出院时静息心率水平为(78.6±6.9)次/min,高于非MACE组患者的(71.1±8.4)次/min(t=7.30,P<0.01);红细胞比容(32.3±3.6)%低于非MACE组患者(36.6±4.9)%(t=-8.22,P<0.01)。静息心率和红细胞比容是射血分数保留型及中间型老年心衰患者易损期内发生MACE的影响因素,多因素Cox回归分析结果显示静息心率HR为1.11(95%CI:1.07~1.14,P<0.01),红细胞比容HR为0.91(95%CI:0.83~0.99,P<0.05)。低静息心率(193例)和高静息心率组(102例)患者生存时间分别为(86.5±1.2)d和(57.9±3.2)d。高静息心率组的生存率(87.3%,89/102)小于低静息心率组(98.4%,190/193),差异有统计学意义(χ^(2)=116.30,P<0.01)。高红细胞比容组(134例)和低红细胞比容组(161例)生存时间分别为(84.6±1.7)d和(67.0±2.4)d。低红细胞比容组的生存率(91.9%,148/161)小于高红细胞比容组(97.8%,131/134),差异有统计学意义(χ^(2)=40.32,P<0.01)。ROC显示静息心率、红细胞比容水平检测截点值分别为73.5次/min、35.4%,静息心率联合红细胞比容检测的ROC下面积(AUC)为0.919(95%CI:0.882~0.947,P<0.05),高于静息心率AUC为0.885(95%CI:0.843~0.919,P<0.05),红细胞比容AUC为0.747(95%CI:0.694~0.796,P<0.05)。结论静息心率、红细胞比容是射血分数保留型及中间型老年心衰患者易损期内发生主要心血管事件的主要影响因素。

Objective To investigate the influencing factors for major adverse cardiovascular events(MACE)in older patients with preserved ejection fraction(HFpEF)or with mid-range ejection fraction(HFmrEF)heart failure in the vulnerable phase.Methods Data for 312 patients with preserved or mid-range ejection fraction heart failure hospitalized at the Department of Geriatrics,General Hospital of Tianjin Medical University from January 2017 to October 2019 were retrospectively collected,and 17 patients were lost to follow-up.A total of 295 elderly patients with preserved or mid-range ejection fraction heart failure were included in this study.According to whether major cardiovascular events occurred in the vulnerable phase(90 d after discharge),patients were divided into a MACE group(n=87)and anon-MACE group(n=208).Baseline data between the two groups were compared.Univariate logistic regression analysis wasused to determine risk factors for patients in the vulnerable phase,and COX regression analysis and Kaplan-Meier survival analysis were conducted to evaluate the influence of resting heart rate and hematocrit on MACE in the vulnerable phase.The predictive value of resting heart rate and hematocrit in MACE was analyzed by the ROC curve.Results The resting heart rate at discharge in the MACE group was(78.6±6.9)bpm,higher than(71.1±8.4)bpm in the non-MACE group(t=7.30,P<0.01),whereas hematocrit was(32.3±3.6)%in the MACE group,lower than(36.6±4.9)%in the non-MACE group(t=-8.22,P<0.01).Resting heart rate and hematocrit were risk factors for MACE in elderly patients with HFpEF or HFmrEF in the vulnerable phase.Multivariate Cox regression analysis showed that HR was 1.11 for resting heart rate(95%CI:1.07-1.14,P<0.001)and 0.91 for hematocrit(95%CI:0.83-0.99,P=0.034).The survival times of patients with low and high resting heart rate were(86.5±1.2)d and(57.9±3.2)d,respectively.The survival rate of the high resting heart rate group(87.3%,89/102)was lower than that of the low resting heart rate group(98.4%,190/193)(χ^(2)=116.30,P<0.01).The survival times of patients with high and low hematocrit values were(84.6±1.7)d and(67.0±2.4)d,respectively.The survival rate of the low hematocrit group(91.9%,148/161)was lower than that of the high hematocrit group(97.8%,131/134)(χ^(2)=40.32,P<0.01).ROC curve analysis revealed that the cut-off values for resting heart rate and hematocrit were 73.5 bpm and 35.4%,respectively.The area under the ROC curve(0.919,95%CI:0.882-0.947,P<0.05)for the diagnosis of MACE using the combination of both parameters was significantly larger than that using resting heart rate(0.885,95%CI:0.843-0.919,P<0.05)or hematocrit(0.747,95%CI:0.694-0.796,P<0.05)alone.Conclusions Resting heart rate and hematocrit are the main influencing factors for MACE in elderly patients with HFpEF or HFmrEF in the vulnerable phase.