Myocardial energy expenditure and factors associated with poor prognosis in patients with heart failure with preserved ejection fraction
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摘要:
目的 分析射血分数保留的心力衰竭患者心肌能量消耗(MEE)情况及预后不良的相关因素。 方法 回顾性收集2020年1月~2021年1月我院收治的107例射血分数保留的心力衰竭患者临床资料，所有患者均进行超声心动图检查，且出院后均随访6月，根据患者随访期间是否发生不良心血管事件(MACE)将患者分为预后良好组(n=72)和预后不良组(n=35)。统计分析射血分数保留的心力衰竭患者预后不良的单因素，采用多因素Logistic回归分析射血分数保留的心力衰竭患者预后不良的危险因素，并对典型病例超声心动图图像进行分析。 结果 107例射血分数保留的心力衰竭患者中，共35例发生MACE，不良预后发生率为32.71%。单因素分析结果显示，预后不良组外周血红细胞计数、血红蛋白水平及左室射血分数(LVEF)低于预后良好组，血清脑钠肽水平及MEE高于预后良好组(P<0.05)。多因素Logistic回归分析结果显示，血清脑钠肽水平高、MEE高、LVEF低均为射血分数保留的心力衰竭患者预后不良的独立危险因素(OR=2.457、3.083、2.986，P<0.05)。 结论 射血分数保留的心力衰竭患者预后不良的独立危险因素包括血清脑钠肽水平高、MEE高、LVEF低，超声心动图MEE和LVEF可用于预测射血分数保留的心力衰竭患者MACE的发生。 Abstract:Objective To analyze the myocardial energy expenditure (MEE) and related factors of poor prognosis in heart failure patients with preserved ejection fraction. Methods Clinical data of 107 patients with heart failure with retained ejection fraction admitted to our hospital from January 2020 to January 2021 were retrospectively collected. All patients underwent echocardiography and were followed up for 6 months after discharge. Patients were divided into the good prognosis group (n=72) and the poor prognosis group (n=35) according to whether adverse cardiovascular events (MACE) occurred during followup. Single factors for poor prognosis in patients with heart failure with preserved ejection fraction were statistically analyzed using multifactorial logistic regression and echocardiographic images were analysed in typical cases. Results A total of 35 of 107 heart failure patients with preserved ejection fraction developed MACE, with an incidence of poor prognosis of 32.71%. Univariate analysis showed that the levels of erythrocyte count, hemoglobin and left ventricular ejection fraction (LVEF) in the poor prognosis group were lower than those in the good prognosis group (P<0.05), while the levels of serum brain natriuretic peptide and MEE were higher than those in the good prognosis group (P<0.05). Multivariate Logistic regression analysis showed that high level of serum brain natriuretic peptide, high MEE and low LVEF were independent risk factors for poor prognosis in heart failure patients with retained ejection fraction (OR=2.457, 3.083, 2.986, P<0.05). Conclusion The independent risk factors for poor prognosis in patients with retained ejection fraction include high level of serum brain natriuretic peptide, high MEE and low LVEF. Echocardiographic MEE and LVEF could be used to predict the development of MACE in patients with heart failure with preserved ejection fraction. -
Key words:
- heart failure /
- ejection fraction /
- prognosis /
- echocardiography /
- myocardial energy /
- influencing factors
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图 1 射血分数保留的心力衰竭患者典型病例图
A：心尖四腔心切面，全心明显增大，左室运动幅度明显减低，右房顶探及心包积液，最深约20 mm；B：心尖四腔心切面，探及三尖瓣少量反流，流速约325 cm/s，估测肺动脉收缩压约53 mm汞柱；C：心尖五腔心切面，测得主动脉前向血流，约107 cm/s；D：左室短轴M型超声心动图，EF测值约38%；E：左室短轴切面，心尖段，侧壁、下壁心包腔积液，最深约8 mm；F：左室长轴切面，左心房内径50 mm，左室内径60 mm，左室壁运动幅度明显减低.
Figure 1. Typical case diagram of heart failure patients with preserved ejection fraction.
表 1 射血分数保留的心力衰竭患者预后不良的单因素分析
Table 1. Univariate analysis of poor outcome in heart failure patients with retained ejection fraction
因素 预后不良组(n=35) 预后良好组(n=72) χ2/t P 性別[n(%)] 0.017 0.896 男 18(51.43) 38 (52.78) 女 17 (48.57) 34 (47.22) 年龄(岁, Mean±SD) 69.37±3.28 70.47±4.10 1.385 0.169 病稈(月，Mean±SD) 24.38±3.29 23.87±3.82 0.677 0.500 合并疾病[n(%)] 高血压 12 (34.29) 25 (34.72) 0.002 0.964 糖尿病 9 (25.71) 18 (25.00) 0.006 0.936 高脂血症 10 (28.57) 18 (25.00) 0.155 0.693 实验室指标(Mean±SD) 空腹血糖(mmol/L) 5.22±1.84 4.76±1.55 1.353 0.179 总胆固醇(mmol/L) 6.26±1.36 6.02±1.19 0.934 0.353 低密度脂蛋白(mmol/L) 4.67±0.83 4.49±0.69 1.183 0.239 血肌酐(pmol/L) 150.73±44.37 146.38±41.96 0.494 0.623 红细胞计数(1x1012/L) 3.77±0.59 4.43±0.68 4.911 < 0.001 血红蛋白(g/L) 109.38±21.83 133.85±19.37 5.879 < 0.001 BNP (pg/mL) 1198.73±102.47 629.38±73.84 32.822 < 0.001 超声心动图指标(Mean±SD) MEE 191.75±55.38 123.57±35.07 7.746 < 0.001 LVEF (%) 57.86±9.12 63.82±9.81 3.506 < 0.001 左室收缩末期内径(mm) 29.90±3.89 30.88±6.16 0.790 0.431 左室舒张末期内径(mm) 46.53±6.28 45.35±6.53 0.790 0.431 E/A值 0.68±0.33 0.69±0.26 0.171 0.865 BNP：脑钠肽；LVEF：左室射血分数；MEE：心肌能量消耗；E/A：二尖瓣血流速度/舒张晚期二尖瓣血流速度. 
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表 2 射血分数保留的心力衰竭患者预后不良的多因素Logistic回归分析
Table 2. Multivariate Logistic regression analysis of poor prognosis in heart failure patients with preserved ejection fraction
影响因素 β SE Wald/c2 P OR 95%CI 外周血红细胞计数水平低 0.973 0.521 3.488 0.062 2.646 0.953~7.346 外周血血红蛋白水平低 1.027 0.664 2.392 0.122 2.793 0.760~10.262 血清BNP水平高 0.899 0.314 8.197 0.004 2.457 1.328~4.547 MEE高 1.126 0.453 6.178 0.013 3.083 1.269~7.492 LVEF低 1.094 0.362 9.133 0.003 2.986 1.469~6.071
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