重度肺动脉高压患者的左心室射血分数及NT-ProBNP与预后相关
Association of left ventricular ejection fraction and NT-ProBNP with prognosis in patients with severe pulmonary arterial hypertension
肖家旺 1王建铭 1庚靖淞 1孟立立 1王忠超 1王琦光1
作者信息
- 1. 中国人民解放军北部战区总医院先心病内科、全军心血管病研究所,辽宁沈阳 110016
- 折叠
摘要
目的 探讨重度肺动脉高压(PAH)患者超声心动图测量左心功能相关参数与预后的关系.方法 回顾性分析2018年 10月～2021年 12月于中国人民解放军北部战区总医院先心病内科住院治疗的 55例第一大类PAH患者(不包括艾森曼格综合征)及慢性血栓栓塞性肺动脉高压.并依据随访中是否出现临床恶化事件分为临床恶化组(n=20)与无临床恶化组(n=35),采用单因素和多因素COX比例风险回归模型、Kaplan-Meier生存曲线分析重度PAH患者超声心动图测量左心功能参数与预后的关系.结果 55例患者中有 20例出现临床恶化事件,其中 2例(4%)发生全因死亡,10例(18%)因PAH恶化再住院,8例(14%)治疗升级.与无临床恶化组相比,临床恶化组的右心室/左心室内径比值、右心室内径与LVEF更大(均P<0.01),每搏量指数与左心室舒张末期内径更小(均P<0.05),血清总胆红素(P<0.05)与NT-ProBNP更高(均P<0.01).多因素Cox风险回归分析表明:LVEF[HR 1.66(1.29～2.14);P<0.01)]及NT-ProBNP[HR 1.001(1.000～1.002);P<0.05]是重度PAH患者预后的独立预测因素.受试者工作特征曲线表明LVEF 71%和NT-ProBNP 724.5 pg/ml是最佳截点值,灵敏度及特异度均较高.Kaplan-Meier生存分析显示 LVEF>71%者及 NT-ProBNP>724.5 pg/ml的临床恶化发生率均显著升高(均P<0.01).结论 超声心动图测量LVEF及NT-ProBNP可很好预测重度PAH患者的临床恶化事件发生率.
Abstract
AIM To investigate the relationship between the parameters related to left heart function measured by echocardiography and the prognosis of patients with severe pulmonary hypertension(PAH).METHODS Out of 55 patients,20 experienced clinical deterioration events,of which 2(4%)experienced all cause death,10(18%)were readmitted due to PAH deterioration,and 8(14%)were upgraded to treatment.Compared with the group without clinical deterioration,the right ventricular/left ventricular diameter ratio,right ventricular diameter,and LVEF in the clinical deterioration group were larger(all P<0.01),stroke volume index and left ventricular end diastolic diameter were smaller(all P<0.05),and serum total bilirubin(P<0.05)and NT ProBNP were higher(all P<0.01).Multivariate Cox risk regression analysis showed that LVEF[HR 1.66(1.29～2.14);P<0.01)]and NT ProBNP[HR 1.001(1.000～1.002);P<0.05]are independent predictors of prognosis in patients with severe PAH.The working characteristic curve of the subjects shows that LVEF 71%and NT ProBNP 724.5 pg/ml are the optimal cutoff values,with high sensitivity and specificity.Kaplan Meier survival analysis showed a significant increase in the incidence of clinical deterioration in patients with LVEF>71%and NT ProBNP>724.5 pg/ml(both P<0.01).CONCLUSION Echocardiographic measurement of LVEF and NT-ProBNP well predict the incidence of clinical deterioration in patients with severe PAH.
关键词
肺动脉高压/超声心动图/右心导管/左心室射血分数Key words
pulmonary arterial hypertension/echocardiography/right heart catheterization/left ventricular ejection fraction引用本文复制引用
出版年
2024
NETL
NSTL
万方数据