| 师彦虎,张帆,孙敏,等.慢性心力衰竭病人射血分数改善影响因素及列线图预测模型构建[J].安徽医药,2024,28(5):929-934. |
| 慢性心力衰竭病人射血分数改善影响因素及列线图预测模型构建 |
| Influencing factors of ejection fraction improvement in patients with chronic heart failure and nomogram prediction model construction |
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| DOI：10.3969/j.issn.1009-6469.2024.05.017 |
| 中文关键词: 心力衰竭 左心室射血分数 预后 超声心动图 |
| 英文关键词: Heart failure Left ventricular ejection fraction Prognosis Echocardiography |
| 基金项目: |
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| 摘要点击次数: 60 |
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| 中文摘要: |
| 目的探讨慢性心力衰竭病人临床预后特征及射血分数( LVEF)改善影响因素并构建预测模型，为后续个体化治疗方案制定提供更多参考。方法研究纳入 2016年 1月至 2018年 3月于宝鸡市中医医院接受治疗慢性心力衰竭病人共 132例，据 LVEF水平分为射血分数改善心力衰竭( HFrecEF)组( 14例)、射血分数下降心力衰竭( HFrEF)组( 37例)及射血分数正常心根力衰竭( HFpEF)组( 81例)；比较各组临床特征资料及随访终点事件发生情况，采用多因素 logistic回归模型评价慢性心力衰竭病人射血分数改善独立影响因素；基于上述独立影响因素构建列线图模型，描绘受试者操作特征( ROC)曲线评估模型预测慢性心力衰竭病人射血分数改善临床效能。结果 HFrecEF组年龄显著低于 HFrEF组及 HFpEF组［(71.08±12.35)岁比( 74.15±11.92)岁、(79.26±14.68)岁， P<0.05］； HFrecEF组女性比例、扩张型心肌病比例、收缩压( SBP)、舒张压( DBP)及静息心率( HR)水平均显著高于其他两组( P<0.05)； HFrecEF组左心室舒张末期内径( LVEDD)、左心室舒张末期容积( LVEDV)、左心房内径(LAD)及合并节段性室壁运动异常比例均显著低于 HFrEF组( P<0.05)； HFrecEF组 LVEDD≤55 mm比例显著高于 HFrEF组(P<0.05)。随访时 HFrecEF组 LVEF水平显著高于入院时( P<0.05)；同时随访时 HFrecEF组 LVEDD、LVEDV及 LAD均显著低于入院时( P<0.05)；②HFrecEF组病死率和心血管相关病死率均显著低于其他两组( P<0.05)；三组猝死率比较差异无统计学意义(P>0.05)。多因素分析结果显示， LVEDD≤55 mm、舒张压 >85 mmHg、静息心率 >90次/分及无陈旧性心肌梗死均是慢性心力衰竭病人射血分数改善独立影响因素( P<0.05)。根据慢性心力衰竭病人射血分数改善影响因素构建列线图模型，建模组和验证组预测慢性心力衰竭病人射血分数改善 AUC分别为 0.97［95%CI:(0.94，0.99)］，0.94［95%CI:(0.91，0.98)］；建模组列线图模型 C-index为 0.97，提示预测模型具有良好区分度。结论慢性心力衰竭病人如 LVEDD≤55 mm、高舒张压、快静息 HR及无陈旧性心肌梗死则射血分数改善比例更高，同时 HFrecEF往往预后更佳；而基于上述影响因素构建列线图模型能够实现病人射血分数改善精准预测。 |
| 英文摘要: |
| Objective To investigate the clinical prognosis characteristics of patients with chronic heart failure (CHF) and the factorsinfluencing the improvement of ejection fraction (LVEF), and to construct the prediction model, so as to provide more reference for sub-sequent individualized treatment plan formulation.Methods One hundred and thirty-two patients with chronic heart failure treated inBaoji Hospital of Traditional Chinese Medicine from January 2016 to March 2018 were enrolled in this study. According to the level ofLVEF, all patients were assigned into three groups: heart failure with improved ejection fraction (HFrecEF) group (14 cases), heart fail-ure with reduced ejection fraction (HFrEF) group (37 cases) and heart failure with normal ejection fraction (HFpEF) group (81 cases).The clinical characteristics and the incidence of follow-up end events were compared. Multivariate logistic regression model was usedto evaluate the independent influencing factors for the improvement of ejection fraction in patients with chronic heart failure. The nomo-gram model was constructed based on the above independent influencing factors, and the ROC curve was delineated to evaluate theclinical efficacy of the model in predicting ejection fraction in patients with chronic heart failure.Results The age of HFrecEF group was significantly lower than that of HFrEF group and HFpEF group [(71.08±12.35) vs. (74.15±11.92), (79.26±14.68) year, P<0.05].The proportion of women, the proportion of dilated cardiomyopathy, the levels of systolic blood pressure (SBP), diastolic blood pressure (DBP) and resting heart rate (HR) of HFrecEF group were significantly higher than those in the other two groups (P<0.05). The propor-tions of left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic volume (LVEDV), left atrial diameter (LAD) andthe proportion of segmental wall motion abnormalities of HFrecEF group were significantly lower than those in HFrEF group (P<0.05). The proportion of LVEDD ≤ 55 mm of HFrecEF group was significantly higher than that in HFrEF group (P<0.05). The level of LVEF with follow-up of HFrecEF group was significantly higher than at admission (P<0.05). At the same time, the level of LVEDD, LVEDV and LAD with follow-up of HFrecEF group was significantly lower than those at admission (P<0.05). The mortality and cardiovascularrelated mortality of HFrecEF group were significantly lower than those in the other two groups (P<0.05). There was no significant differ-ence in sudden death rate among three groups (P>0.05). Multivariate analysis showed that LVEDD≤55 mm, diastolic blood pressure>85 mmHg, resting HR>90 times/min and no old myocardial infarction were independent influencing factors for the improvement of ejec-tion fraction in patients with chronic heart failure (P<0.05). The nomogram model was constructed according to the influencing factorsof ejection fraction improvement in patients with chronic heart failure. The AUC of predicting the improvement of ejection fraction inpatients with chronic heart failure in the modeling group and the validation group were 0.97[95%CI:(0.94,0.99)] and 0.94[95%CI:(0.91, 0.98)], respectively. The C-index of the nomogram model of the modeling group was 0.97,indicating that the prediction model had good discrimination.Conclusions Patients with chronic heart failure, such as LVEDD ≤55 mm,high diastolic blood pressure, rapid restingHR and no old myocardial infarction, have the higher improvement rate of ejection fraction,and patients with HFrecEF often has the bet-ter prognosis. The nomogram model based on the above influencing factors can accurately predict the improvement of ejection fraction. |
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