急性心肌炎患者应用降心率药物的预后效果分析

Analysis of the Prognostic Effect of Heart Rate-Lowering Drugs Applied to Pa⁃tients with Acute Myocarditis

目的探讨早期使用降心率药物进行心率控制对急性心肌炎患者远期预后的影响。方法回顾性收集2015年1月至2022年11月在南京鼓楼医院住院治疗的267例急性心肌炎患者的临床资料,根据是否使用降心率药将患者分为药物干预组和非药物干预组。以主要不良心血管事件(major adverse cardiovascular event,MACE)发生或至随访结束为随访终点。绘制Kaplan-Meier生存曲线,分析两组患者发生MACE的差异。采用Cox比例风险回归模型分析早期心率控制对MACE发生风险的影响。结果中位随访时间为49.5(28~69)个月,Kaplan-Meier生存曲线比较显示非药物干预组的累计MACE发生率显著高于药物干预组,差异有统计学意义(P=0.037)。多因素Cox比例风险回归模型分析显示,合用降心率药(P<0.05)、出院静息心率(P<0.05)、心率降幅(P<0.05)、合用血管活性药物(P<0.01)是急性心肌炎患者预后发生MACE的影响因素。结论早期对急性心肌炎患者使用降心率药物有利于降低其远期MACE发生率。

Objectives To investigate the effect of early heart rate control with heart rate lowering drugs on the long-term prognosis of patients with acute myocarditis.Methods The clinical data of 267 patients with acute myocarditis hospitalized in Nanjing Drum Tower Hospital from January 2015 to November 2022 were retrospectively collected,and the patients were divided into drug intervention group and non-pharmacological intervention group according to whether they were taking heart rate lowering drugs or not.The occurrence of major adverse cardiovascular event(MACE)or until the end of follow-up was used as the follow-up endpoint.Kaplan-Meier survival curves were plotted to analyze the differ‐ence in the occurrence of MACE between the two groups.Cox proportional risk regression model was used to analyze the effect of early heart rate control on the risk of MACE occurrence.Results At a median follow-up of 49.5(28-69)months,comparison of Kaplan-Meier survival curve showed that the cumulative incidence of MACE was significantly higher in non-pharmacological intervention group than in drug intervention group(P=0.037),and multifactorial Cox proportional risk regression model analysis showed that the combination of heart rate lowering drugs(P<0.05),discharge resting heart rate(P<0.05),heart rate reduction(P<0.05),and co-administration of vasoactive drugs(P<0.01)were influential factors in the prognosis of MACE in patients with acute myocarditis.Conclusions Early heart rate control in patients with acute myocarditis is beneficial in reducing the incidence of MACE in the distant future.