冠状动脉慢性完全闭塞病变经皮介入治疗术后射血分数改善型心力衰竭的预测因素及预后

Predictors and prognosis of heart failure with improved ejection fraction after chronic total occlusion percutaneous coronary intervention

目的:探究冠状动脉(冠脉)慢性完全闭塞病变经皮介入治疗(CTO-PCI)术后射血分数改善型心力衰竭(心衰)的影响因素及其长期预后。方法:回顾性入选CTO-PCI术前左室射血分数(LVEF)≤40%的心衰患者229例,根据术后1年LVEF的变化分为射血分数改善型心衰(HFimpEF)组(71例)和非射血分数改善型心衰(non-HFimpEF)组(158例)。采用logistic回归筛选CTO-PCI术后HFimpEF的影响因素;使用Cox回归探究主要不良心血管事件(MACE)的影响因素,并通过Kaplan-Meier生存分析比较两组的预后差异,同时基于倾向性评分匹配(PSM)进行敏感性分析。结果:Logistic回归结果示,年龄<60岁、左室舒张末期内径(LVEDD)<60 mm、J-CTO评分<3以及应用β受体阻滞剂和钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)与CTO-PCI术后射血分数改善相关(P<0.05)。PSM前后的Cox回归结果均表明,HFimpEF是患者CTO-PCI术后发生MACE的独立保护因素(P<0.01)。PSM前后的Kaplan-Meier曲线显示HFimpEF组的无MACE生存率高于non-HFimpEF组(P<0.01)。结论:年龄<60岁、LVEDD<60 mm、J-CTO评分<3以及应用β受体阻滞剂和SGLT2i是CTO-PCI术后HFimpEF的独立影响因素,HFimpEF患者拥有更好的长期预后。

Objective To investigate the predictors and long-term prognosis of heart failure with improved ejection fraction(HFimpEF)after chronic total occlusion percutaneous coronary intervention(CTO-PCI).Methods A total of 229 heart failure patients with left ventricular ejection fraction(LVEF)≤40%before CTO-PCI were retrospectively enrolled and divided into HFimpEF group(n=71)and non-HFimpEF group(n=158)according to the change in LVEF at 1 year after CTO-PCI.Binary logistic regression was used to screen the predictors of HFimpEF after CTO-PCI.Cox regression was used to explore the factors influencing major adverse cardiovascular events(MACE).Kaplan-Meier survival analysis was used to compare the prognostic differences between two groups,and sensitivity analysis was performed based on propensity score matching(PSM).Results Logistic regression analysis showed that age<60 years,left ventricular end-diastolic diameter(LVEDD)<60 mm,J-CTO score<3,and the use ofβ-blockers and sodium-glucose cotransporter 2 inhibitors(SGLT2i)were associated with improved ejection fraction after CTO-PCI(P<0.05).Cox regression analysis before and after PSM showed that HFimpEF was an independent protective factor for MACE after CTO-PCI(P<0.01).Kaplan-Meier survival analysis showed higher MACE-free survival in the HFimpEF group than in the non-HFimpEF group(P<0.01).Conclusion Age<60 years,LVEDD<60 mm,J-CTO score<3,and the use ofβ-blockers and SGLT2i were predictors of HFimpEF after CTO-PCI,and this patient population had a better long-term prognosis.