俯身呼吸困难与射血分数正常心力衰竭患者预后的相关性

金丹玲; 刘兆军

俯身呼吸困难与射血分数正常心力衰竭患者预后的相关性

Impact of bendopnea on chronic heart failure with normal ventricular ejection

摘要

摘要: 目的观察和分析俯身呼吸困难与射血分数(EF)正常的心力衰竭（HFnEF）患者预后的相关性。方法入选HFnEF患者162例,按照有无俯身呼吸困难分为俯身呼吸困难组（n=82）和非俯身呼吸困难组（n=80），进行为期2年的随访，随访终点指标：全因性死亡/心源性死亡联合终点，心衰再入院治疗，心功能恶化至IV级，左室EF（LVEF）<50%，6分钟步行距离（6MWD）<300 m，血清N末端脑钠尿肽前体（NT-ProBNP）>1 200 ng/ml。Kaplan-Meier法描述生存率，Cox比例风险模型用以计算风险比（HR）及95%CI，分析俯身呼吸困难与心力衰竭患者临床结果的关系。结果完全随访患者158例，失访4例，随访率97.5%，俯身呼吸困难组（n=80）和非俯身呼吸困难组（n=78）经Cox多因素分析校正后，两组间病死率无显著差异，俯身呼吸困难组的心衰再住院率显著高于非俯身呼吸困难组（24% vs. 18%，P<0.01），俯身呼吸困难组LVEF值<50%比例显著高于非俯身呼吸困难组（14% vs. 7%，P<0.05），俯身呼吸困难组心功能恶化至IV级的患者较非俯身呼吸困难组高（16% vs. 9%，P<0.05），俯身呼吸困难组血清NT-ProBNP>1 200 ng/ml，6MWD<300 m患者比例均显著高于非俯身呼吸困难组（13% vs. 10%，19% vs. 14%，均P<0.05）。结论 EF正常的心力衰竭患者中存在俯身呼吸困难者其心功能恶化风险升高。

Abstract: AIM To explore the clinical value of bendopnea in chronic heart failure with normal ejection fraction. METHODS According to the clinical outcomes at 2-year follow-up, chronic heart failure patients were divided into a bendopnea group and a non-bendopnea group. Research metrics included death, cardiac death, re-admission to hospital for heart failure, heart function aggravating to IV degree, EF less than 50%, 6-minute walking distance less than 300 meters and/or blood NT-ProBNP more than 1 200 ng/ml. Kaplan-Meier survival curves and Cox regression models were used to examine the association of bendopnea with clinical outcomes. RESULTS Out of 162 total patients, 158 (97.5%) completed the 2-year follow-up and bendopnea was administered in 80 patients (50.6%). After mutltivariate adjusting, there was no difference in death/cardiac death rates between the bendopnea group and non-bendopnea group. The rate of hospital re-admission for heart failure in the bendopnea group was higher than that in the non-bendopnea group (24% vs. 18%, P<0.01). The rate of EF less than 50% in the bendopnea group was higher than that in the non-bendopnea group (14% vs. 7%, P<0.05). The rate of heart functions aggravating to IV degree in the bendopnea group was higher than that in the non-bendopnea group (16% vs. 9%, P<0.05). The rate of blood NT-ProBNP more than 1 200 ng/ml in the bendopnea group was higher than that in the non-bendopnea group (13% vs. 10%, P<0.05). Finally, the rate of 6-minute walking distance less than 300 meters in the bendopnea group was higher than that in the non-bendopnea group (19% vs. 14%, P<0.05). CONCLUSION Bendopnea elevates the risk of heart function aggravation in chronic heart failure with normal ventricular ejection.

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