[1]郭志念,杨杰,刘川,等.肺动脉收缩压对心脏再同步化治疗患者术后超反应及预后的影响[J].第三军医大学学报,2019,41(02):130-136.
 GUO Zhinian,YANG Jie,LIU Chuan,et al.Effect of pulmonary artery systolic pressure on super-response and prognosis in patients after cardiac resynchronization therapy[J].J Third Mil Med Univ,2019,41(02):130-136.
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肺动脉收缩压对心脏再同步化治疗患者术后超反应及预后的影响(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第02期
页码:
130-136
栏目:
临床医学
出版日期:
2019-01-30

文章信息/Info

Title:
Effect of pulmonary artery systolic pressure on super-response and prognosis in patients after cardiac resynchronization therapy
作者:
郭志念杨杰刘川刘小燕成小凤陈运龙张勇翁显贵王蓉王江
陆军军医大学(第三军医大学)第二附属医院心血管内科, 全军心血管病研究所
Author(s):
GUO Zhinian YANG Jie LIU Chuan LIU Xiaoyan CHENG Xiaofeng CHEN Yunlong ZHANG Yong WENG Xiangui WANG Rong WANG Jiang

Institute of Cardiology, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China

关键词:
心脏再同步化治疗肺动脉收缩压超反应预后
Keywords:
cardiac resynchronization therapy pulmonary artery systolic pressure super-response prognosis
分类号:
R331.36; R540.4; R541.7
文献标志码:
A
摘要:

目的 评估术前肺动脉收缩压(pulmonary artery systolic pressure,PASP)对心脏再同步化治疗(cardiac resynchronization therapy,CRT)患者术后心功能、左心室重构和预后的影响。方法回顾性分析2014年6月至2017年12月在本院进行CRT的73例患者资料,根据超声心动图估测的术前PASP分成两组:肺动脉高压组(PASP≥50 mmHg)27例和非肺动脉高压组(PASP<50 mmHg)46例。CRT术后6个月评估心功能,复查心电图和超声心动图,并比较两组之间的差异,采用ROC曲线评估术前PASP对CRT超反应的预测价值,采用KaplanMeier法进行生存分析,采用Cox回归模型分析影响长期预后的危险因素。结果 73例患者中男性 52 例,女性 21 例,年龄(60.32±9.78)岁。CRT术后肺动脉高压组纽约心脏协会(New York Heart Association, NYHA) 心功能分级、左室射血分数(left ventricular ejection fraction,LVEF)和左心室舒张末期内径(left ventricular enddiastolic dimension,LVEDD)改善程度较非肺动脉高压组差(P<0.05),肺动脉高压组LVEDD较术前无改善(P>0.05)。术前PASP≤35 mmHg对CRT超反应有一定的预测价值(AUC:0.709,95% CI:0.575~0.843,P<0.05)。肺动脉高压组复合终点事件(心衰再入院或全因死亡)发生率高于非肺动脉高压组(P<0.05),肺动脉高压(HR:3.64,95%CI:1.25~10.61,P<0.05)、左心房内径(left atrial dimension,LAD) (HR:1.10,95%CI:1.01~1.20,P<0.05)是影响CRT术后患者预后的独立危险因素。结论 术前PASP升高的患者CRT术后心功能改善、左室重构逆转的效果和临床预后较术前PASP正常的患者差,术前PASP≤35 mmHg对CRT超反应有预测价值,肺动脉高压、LAD是CRT术后患者临床预后的独立危险因素。

Abstract:

Objective To evaluate the impact of baseline pulmonary artery systolic pressure (PASP) on cardiac function, left ventricle reverse remodeling and clinical outcomes in patients receiving cardiac resynchronization therapy (CRT). Methods A total of 73 patients undergoing CRT in our hospital between June, 2014 and December, 2017 were enrolled in this retrospective analysis. According to baseline PASP estimated by echocardiography, the patients were divided into pulmonary artery hypertension (PAH) group (PASP≥ 50 mmHg; n=27) and non-pulmonary artery hypertension (NPAH) group (PASP<50 mmHg; n=46) for comparison of cardiac function, electrocardiogram and echocardiogram at 6 months after CRT. A receiver operator characteristic (ROC) curve was used to evaluate the value of baseline PASP in predicting superresponse to CRT. The combined endpoints including all-cause mortality and rehospitalization for heart failure were compared between the 2 groups using Kaplan-Meier analysis. Cox regression models were constructed to analyze the risk factors for long-term prognosis of the patients. Results The 73 patients enrolled included 52 male and 21 female patients at a mean age of 60.32±9.78 years. At 6 months after the operation, the patients in PAH group had significantly poorer improvements in cardiac functions, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) than those in NPAH group (P<0.05), and showed no obvious improvement in LVEDD (P>0.05). ROC curve analysis showed that PASP ≤35 mmHg was capable of predicting super-response to CRT with an area under the ROC curve of 0.709 (95%CI: 0.575-0.843, P<0.05). The patients in PAH group had a higher incidence of combined endpoints than those in NPAH group. PAH (HR=3.64, 95%CI: 1.25-10.61, P<0.05) and left atrial diameter (HR=1.10, 95%CI: 1.01-1.20, P<0.05) were independent predictors for the clinical outcomes of the patients. Conclusion Patients with elevated baseline PASP have poorer improvements in cardiac function, left ventricle reverse remodeling and prognosis following CRT than those with normal PASP. A baseline PASP ≤35 mmHg is predictive of super-response to CRT, and PAH and left atrial diameter are independent predictors of the clinical outcomes following CRT.
 

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更新日期/Last Update: 2019-01-22