特发性扩张型心肌病患者左心室逆重构的发生率、预测因素和预后分析

目的探讨特发性扩张型心肌病患者左心室逆重构(LVRR)的发生率、预测因素及预后。方法回顾性分析2014年1月至2017年5月于焦作市第二人民医院住院的51例特发性扩张型心肌病患者的一般临床资料和超声心动图数据,以复查时左心室射血分数(LVEF)绝对值增加10%以上的患者为LVRR组,LVEF绝对值增加低于10%的为NLVRR组。计算LVRR的发生率,采用logistic回归分析LVRR的预测因素,比较两组心力衰竭恶化再住院率,并采用Kaplan-Meier生存曲线法分析两组死亡率。结果特发性扩张型心肌病患者LVRR的发生率为51.0%(26/51)。LVRR的预测因素为心力衰竭病史<1年(OR=0.065,95%CI:0.007~0.562,P=0.013)和首次LVEF≥35%(OR=23.457,95%CI:2.687~204.770,P=0.004)。LVRR组的住院次数为2.8±2.9,NLVRR组为3.4±2.3,两组比较差异有统计学意义(P=0.003)。Kaplan-Meier生存曲线法分析显示,LVRR组患者的预后优于NLVRR组(95%CI:96.442~120.323和95%CI:69.909~98.364,P=0.017)。结论特发性扩张型心肌病患者的LVRR发生率为51.0%,心力衰竭病史小于1年和首次LVEF≥35%为其预测因素,此类患者预后改善。

Analysis of incidence,predictive factors and prognosis of left ventricular reverse remodeling in patients with idiopathic dilated cardiomyopathy

Objective To investigate the incidence,predictive factors and prognosis of left ventricular reverse remodeling(LVRR)in patients with idiopathic dilated cardiomyopathy(DCM).Methods A total of 51 DCM patients were retrospectively enrolled in the Second People s Hospital of Jiaozuo City from January 2014 to May 2017.The general clinical data and echocardiographic data were collected.LVRR group was defined as those whose absolute increased value of left ventricular ejection fraction(LVEF)more than 10%at follow-up.NLVRR group was defined as those whose absolute increased value of LVEF less than 10%.The incidence of LVRR was calculated,and the predictive factors of LVRR were analyzed by logistic regression.The re-hospitalization rates of heart failure exacerbation in the two groups were compared,and Kaplan-Meier analysis was used to analyze the mortality in the two groups.Results The incidence of LVRR in patients with idiopathic DCM was 51.0%(26/51).The predictive factors of LVRR were heart failure history less than 1 year(OR=0.065,95%CI:0.007-0.562,P=0.013)and first time of LVEF≥35%(OR=23.457,95%CI:2.687-204.770,P=0.004).The number of hospitalizations in LVRR group was 2.8±2.9 and that in NLVRR group was 3.4±2.3 with significant difference(P=0.003).Kaplan-Meier survival curve analysis showed that the prognosis in LVRR group was better than NLVRR group(95%CI:96.442-120.323 and 95%CI:69.909-98.364,P=0.017).Conclusions The incidence of LVRR in patients with idiopathic DCM is 51.0%.The predictors of LVRR are the heart failure history less than one year and the first time of LVEF≥35%.The prognosis of LVRR patients is improved better than NLVRR patients.