心脏超声对急性心力衰竭患者不良事件的预测价值

Predictive value of cardiac ultrasound for adverse events in patients with acute heart failure

目的:探究心脏超声对急性心力衰竭(AHF)患者不良事件的预测价值。方法:选择2021年11月~2022年12月本院收治的AHF患者100例作为研究对象。所有患者均采用彩色多普勒心脏超声检测心功能指标,包括二尖瓣舒张早期峰值流速(E)和晚期峰值流速(A),并计算E/A比值、左心室射血分数(LVEF)和心肌做功(Tei)指数。根据6个月随访期内是否发生不良事件,将其分为事件组(n=36)和无事件组(n=64),对比两组的E/A、LVEF和Tei指数。绘制受试者工作特征曲线(ROC)分析E/A、LVEF和Tei指数单独及联合检测对AHF患者发生不良事件的预测价值。结果:所有AHF患者均完成6个月的随访,其中包括28例因心衰再入院治疗,8例死亡。与无事件组相比,事件组E/A[(0.98±0.10)比(0.79±0.16)]和LVEF[(42.63±4.89)%比(37.86±4.41)%]显著降低,Tei指数[(0.44±0.27)比(0.58±0.21)]显著升高,P均<0.01。Logistic回归模型显示年龄和Tei指数是AHF患者发生不良事件的独立危险因素(OR=3.728、6.878,P均=0.001),而E/A和LVEF是其独立保护因素(OR=0.519、0.350,P<0.05或<0.01)。E/A、LVEF和Tei指数联合检测预测AHF患者不良事件的AUC为0.903,显著高于单独LVEF检测(Z=2.207,P=0.043)。结论:E/A、LVEF联合Tei指数检测对AHF患者发生不良事件具有较高预测价值,可作为临床预测AHF预后的一种新型方案,以尽早采取相应的治疗,改善预后。

Objective:To investigate the predictive value of cardiac ultrasound for adverse events in patients with acute heart failure(AHF).Methods:A total of 100 AHF patients admitted to our hospital from November 2021 to December 2022 were selected.Color Doppler echocardiography was used to detect cardiac function indexes in all patients,including mitral early diastolic peak velocity(E)and late peak velocity(A),and E/A ratio was calculated,left ventricular ejection fraction(LVEF)and Tei index.According to occurrence of adverse events within six-month follow-up or not,they were divided into event group(n=36)and no event group(n=64).E/A,LVEF and Tei index were compared between two groups.Receiver operating curve(ROC)was plotted to analyze the predictive value of E/A,LVEF,Tei index and their combined detection for adverse events in AHF patients.Results:All AHF patients completed 6-month follow-up,including 28 cases of readmission due to heart failure and 8 cases of death.Compared with no event group,there were significant reductions in E/A[(0.98±0.10)vs.(0.79±0.16)]and LVEF[(42.63±4.89)%vs.(37.86±4.41)%],and significant rise in Tei index[(0.44±0.27)vs.(0.58±0.21)]in event group,P<0.01 all.Logistic regression model suggested that age and Tei index were independent risk factors for adverse events in AHF patients(OR=3.728,6.878,P=0.001 both),while E/A and LVEF were its independent protective factors(OR=0.519,0.350,P<0.05 or<0.01).The AUC of combined detection of E/A,LVEF and Tei index predicting adverse events in AHF patients was 0.903,significantly higher than that of LVEF alone(Z=2.207,P=0.043).Conclusion:The combined detection of E/A,LVEF and Tei index possesses high predictive value for adverse events in AHF patients,which can be used as a new program for clinical prediction of AHF prognosis,so as to take corresponding treatment as soon as possible and improve prognosis.