摘要
目的 探讨心肺运动试验(CPET)参数联合N末端脑钠肽前体(NT-proBNP)是否可以预测射血分数保留心力衰竭(HFp EF)患者的不良预后.方法 入选2017年12月16日至2022年8月16日于阜外华中心血管病医院住院且完成CPET的119例HFp EF患者,收集基线资料,根据随访中是否发生主要心血管不良事件(MACE)分为预后良好组(n=92)和预后不良组(n=27).比较两组患者的基线资料,多因素Logistic回归筛选HFp EF患者不良预后的独立危险因素,绘制受试者工作特征曲线(ROC)分析各独立因素和联合预测因子(L联合)对HFpEF患者不良预后的预测价值.结果 在随访期内(中位数为27个月),有27例患者出现MACE事件(2例心源性死亡,25例因心力衰竭加重再次住院).预后不良组NT-proBNP显著高于预后良好组(P＜0.05).心肺运动参数中,预后不良组峰值摄氧量(peak VO2)、峰值摄氧量占预计值百分比(peak VO2%pred)、峰值心率占预计值百分比(peak HR%pred)、1 min心率恢复(HRR1)、峰值潮气末二氧化碳分压(peak PETCO2)均显著低于预后良好组(P＜0.05),预后不良组二氧化碳通气当量斜率(VE/VCO2 slope)显著高于预后良好组(P＜0.05).多因素Logistic回归分析显示,peak VO2%pred降低、NT-proBNP和VE/VCO2 slope升高是HFp EF患者不良预后的独立危险因素(P＜0.05).ROC曲线分析显示,VE/VCO2 slope、peak VO2%pred、NT-proBNP及L联合预测HFpEF患者不良预后的曲线下面积(AUC)分别为 0.756、0.682、0.817和0.870,最佳阈值分别为35.50、69.50%、754.00 pg/ml和2685.25.结论 VE/VCO2 slope、peak VO2%pred、NT-proBNP是HFpEF患者不良预后的独立预测因素,三者联用具有更好的预测效能.
Abstract
Objective To discuss whether cardiopulmonary exercise testing(CPET)combined with N-terminal pro-brain natriuretic peptide(NT-proBNP)could predict a poor prognosis or not in patients with heart failure with preserved ejection fraction(HFpEF).Methods HFpEF patients undergone CPET(n=119)were chosen from Fuwai Central China Cardiovascular Hospital from Dec.16,2017 to Aug.16,2022.The baseline materials were collected,and according to whether major adverse cardiovascular events(MACE)occurred or not during follow-up period,into good prognosis group(n=92)and poor prognosis group(n=27).The baseline materials were compared between 2 groups,and independent risk factors of poor prognosis were screened by using multi-factor Logistic regression analysis in HFpEF patients.The predictive value of independent factors and combined predictive factors to poor prognosis were analyzed through drawing receiver operating characteristic(ROC)curve.Results During follow-up period(median=27 months),there 27 cases of MACE(2 with cardiac death,25 re-hospitalized due to exacerbated heart failure),and NT-proBNP was significantly higher in poor prognosis group than that in good prognosis group(P<0.05).Among CPET parameters,the peak oxygen uptake(peak VO2),percentage of peak oxygen uptake to predicted value(peak VO2%pred),percentage of peak heart rate to predicted value(peak HR%pred),1-min heart rate recovery(HRR1)and peak end-tidal carbon dioxide partial pressure(peak PETCO2)were significantly lower(P<0.05),and slope of carbon dioxide ventilation equivalent(VE/VCO2 slope)was significantly higher(P<0.05)in poor prognosis group than those in good prognosis group.The results of multi-factor Logistic regression analysis showed that decreased peak VO2%pred and increased NT-proBNP and VE/VCO2 slope were independent risk factors of poor prognosis in HFpEF patients(P<0.05).The results of ROC curve analysis showed that,in predicting poor prognosis,AUC of VE/VCO2 slope was 0.756,AUC of peak VO2%pred was 0.682,AUC of NT-proBNP was 0.817 and AUC of combined predictive factors was 0.870,and the optimal threshold value was,respectively,35.50 pg/ml,69.50%pg/ml,754.00 pg/ml and 2685.25.Conclusion VE/VCO2 slope,peak VO2%pred and NT-proBNP are independent predictive factors of poor prognosis,and combination of them had a higher predictive efficacy in HFpEF patients.
基金项目
河南省医学科技攻关联合共建项目(LHGJ20220119)
NETL
NSTL
维普
万方数据