扩张型心肌病患者经标准药物治疗后左心室射血分数恢复正常的发生率及预测因素分析

摘要

目的:分析扩张型心肌病患者经标准药物治疗后左心室射血分数(LVEF)恢复正常的发生率及其预测因素. 方法:入选2008-10至2013-10在阜外心血管病医院心力衰竭(心衰)病房住院接受标准抗心衰药物治疗的扩张型心肌病患者,出院后随访至2014-09或发生全因死亡或心脏移植.根据复查超声心动图结果,定义随访LVEF绝对值较基线至少提高10%且LVEF>50%为恢复正常标准.调查抗心衰药物治疗下扩张型心肌病患者LVEF恢复正常的发生率.根据LVEF恢复情况分为LVEF恢复组和LVEF未恢复组.收集患者首次入院时的临床和超声心动图指标,采用多变量Logistic回归分析方法分析LVEF恢复正常的基线预测指标.以全因死亡或心脏移植为临床终点事件,应用Kaplan-Meier法进行生存分析,两组间比较采用Log-rank检验.结果:共有322例有完整超声心动图随访结果的扩张型心肌病患者纳入本研究分析.超声心动图中位随访25个月后, LVEF恢复组的91例(28.3%)患者LVEF恢复正常,其LVEF由基线时32.1%±6.1%明显提高至58.2%±4.9%(P<0.01),而LVEF未恢复组的231例未恢复患者LVEF仅增加6.7%±8.3%.多变量Logistic回归分析结果显示,患者入院时心衰病史短(≤ 6个月vs > 6个月,OR=0.330,P<0.01)、收缩压水平高[每升高10 mmHg(1 mmHg=0.133 kPa),OR=1.312, P<0.01]、心电图QRS间期短(OR=0.979,P<0.01)、超声心动图测量的左心室舒张末期内径(LVEDD)小(OR=0.960, P<0.01)、LVEF高(OR=1.063,P<0.05)及出院带药应用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(OR=2.579, P<0.05)是扩张型心肌病患者LVEF恢复正常的独立预测因素.生存分析结果显示,LVEF恢复正常患者的长期无心脏移植生存率明显高于未恢复患者(P<0.01).结论:部分扩张型心肌病患者经过标准抗心衰药物治疗后LVEF可以恢复正常,这与患者入院时心衰病史、收缩压水平、心电图QRS间期、超声测量LVEDD和LVEF水平及应用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂有关.%Objective: To analyze the occurrence and predictor for the recovery of left ventricular ejection fraction (LVEF) in patients with dilated cardiomyopathy (DCM) after standard medication. Methods: We retrospectively studied DCM patients with heart failure (HF) admitted in our hospital from 2008-10 to 2013-10, and a total of 322 patients having entire information were enrolled in this research. All patients receive standard medication and they were followed–up until 2014-09 or until death or heart transplantation after discharge. According to echocardiography, the recovered LVEF was defined as that the absolute value of LVEF must be elevated at least 10% from the baseline and meanwhile, LVEF > 50%. The patients were divided into 2 groups based on if their LVEF recovered to normal level: Recovered group, n =91(28.3%), and Unrecovered group, n =231. The clinical data at admissionand the variables by echocardiography as potential relevant factors of LVEF recovery were studied by Logistic regressionanalysis, the endpoints were all cause death or heart transplantation. Survival analysis was conducted by Kaplan-Meiermethod and the comparison between 2 groups was done by log-rank test.Results: With a median follow-up period of 25 months, LVEF in Recovered group from (32.1% ± 6.1%) of baselineincreased to (58.2%±4.9%), P <0.01, while in Unrecovered group, LVEF only increased (6.7% ± 8.3%). Multivariablelogistic regression analysis presented that shorter history of HF (≤ 6 months vs > 6 months, OR=0.330, P <0.01), highersystolic blood pressure (per 10 mmHg elevation, OR=1.312, P <0.01), shorter QRS interval (OR=0.979, P <0.01),smaller left ventricular end-diastolic diameter (LVEDD) (OR=0.960, P <0.01), higher LVEF (OR=1.063, P <0.05) andthe application of ACEI/ARB upon discharge (OR=2.579, P <0.05) were the independent predictors for LVEF recovery.Survival analysis showed that the patients with recovered LVEF had obviously higher survival rate than unrecoveredpatients, P <0.01.Conclusion: With standard medication, a part of DCM patients with HF could have their LVEF recovered to normallevel, which related to the history of HF, systolic blood pressure, QRS duration, LVEDD, LVEF and the application ofACEI/ARB upon discharge.