目的：研究超声心动图多参数计分（EMPS）评估心力衰竭患者左心室整体功能及预后的价值。方法选取320例心力衰竭患者，采用EMPS对其瓣膜功能指标、左室收缩功能及舒张功能指标、肺动脉压力指标和左室重构指标进行评分；同时测定患者血浆BNP水平，并对患者进行NYHA分级；比较EMPS和BNP水平及NYHA分级之间的相关性。计算EMPS诊断心力衰竭的准确率、敏感性和特异性。对于所有患者进行为期3年的随访，采取Cox比例风险模型分析EMPS对于临床终点预测的价值。结果NYHA分级越高，其EMPS评分越高（P＜0.01）；EMPS≥2对于NYHA II级以上心衰诊断的准确率、敏感性、特异性分别为86.8%、94%和82%；EMPS评分和血浆logBNP呈正相关（P＜0.01）。EMPS被证实能独立预测死亡这一终点事件，且EMPS=4在ROC曲线中被证实可作为预测终点的界值。结论EMPS对于评估心力衰竭患者左心室整体功能和预后具有较高的准确性，值得临床推广。%Objective To explore the value of echocardiographic multi-parameter scoring (EMPS) in evaluating left ventricular functions and prognosis of patients with heart failure. Methods Various parameters including valve function, left ventricular systolic function, left ventricular diastolic function, pulmonary arterial pressure and left ventricular remodeling of 320 patients with heart failure were graded through EMPS. Plasma BNP levels of the patients were measured while NYHA classification of the patients was also conducted. Then the correlation between EMPS scores and NYHA grades as well as the correlation between EMPS scores and plasma BNP levels were calculated. The accuracy, sensitivity and speciifcity of EMPS in diagnosing heart failure were also calculated. After 3 years follow-up for all the patients, the value of EMPS in predicting clinical endpoint was analyzed through Cox proportional hazards model. Results The higher the NYHA grades, the higher the EMPS scores (P<0.01). The accuracy, sensitivity and speciifcity of EMPS (scores≥2) in diagnosing heart failure (NYHA grades≥II) were 86.8﹪, 94﹪and 82﹪, respectively. There was a positive correlation between EMPS scores and logBNP values (P<0.01). The analysis results of Cox proportional hazards model showed that EMPS could predict death independently and EMPS score which was 4 could be choosed as the critical value of prediction termination. Conclusion EMPS which can evaluate left ventricular functions and prognosis of patients with heart failure with high accuracy should be promoted in clinic.
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