Dias P, Rodrigues R A, Queirós M C, Monteiro E, Pimenta J, Friões F, Ferreira A, Bettencourt P
Serviço de Cardiologia e Serviço de Medicina 3 do Hospital de S. João-Porto.
Rev Port Cardiol. 2001 Dec;20(12):1223-32.
It is recognized that heart failure patients with preserved left ventricular systolic function have better prognosis; nevertheless, there are some studies with conflicting results. Also, there is a paucity of data concerning the prognostic factors in this group of patients.
To determine possible variables with prognostic relevance in heart failure patients with preserved left ventricular systolic function (ejection fraction > 40%).
157 consecutive ambulatory patients with heart failure were assessed; those patients with ejection fraction > 40% were included in the study (n = 46). All patients were evaluated by clinical interview and physical examination, ECG, echocardiogram (M-mode, 2D and pulsed Doppler of mitral flow), biochemical study and determination of type B natriuretic peptide (BNP). The patients were grouped according to the rhythm presented on ECG: Group I--patients with atrial fibrillation; Group II--patients in sinus rhythm Group II was further subdivided in two groups according to the presence or absence of restrictive left ventricular filling pattern. All patients had a clinical follow-up, with recording of events (death or hospitalization from cardiac cause). The mean follow-up time was 682.2 +/- 55 days.
The mean age of the patients was 70.4 +/- 1.2 years; 54.3% were women; mean ejection fraction was 49.6 +/- 1%; mean BNP levels were 202.9 +/- 41.3 pg/ml. Mortality was 19.6% and the combined event death or hospitalization from cardiac cause) occurred in 26.1% of the patients. Among the clinical, demographic, biochemical, echocardiographic and neurohumoral parameters, only BNP levels had prognostic significance in the whole population. In Group II patients, BNP levels, heart rate and restrictive left ventricular filling pattern were identified as having prognostic significance. Kaplan-Meyer curve analysis showed that both BNP and restrictive left ventricular filling pattern seemed to be important prognostic markers.
This preliminary study suggests thar neurohumoral activity (determined by plasma BNP levels) and a restrictive ventricular filling pattern may be important factors in prognostic stratification of heart failure patients with preserved left ventricular systolic function.
人们认识到左心室收缩功能保留的心力衰竭患者预后较好；然而，一些研究结果相互矛盾。此外，关于这组患者预后因素的数据也很匮乏。
确定左心室收缩功能保留（射血分数>40%）的心力衰竭患者中具有预后相关性的可能变量。
对157例连续的门诊心力衰竭患者进行评估；射血分数>40%的患者纳入研究（n = 46）。所有患者均通过临床访谈、体格检查、心电图、超声心动图（M型、二维及二尖瓣血流脉冲多普勒）、生化研究及B型利钠肽（BNP）测定进行评估。患者根据心电图显示的心律分组：I组——房颤患者；II组——窦性心律患者。II组根据是否存在左心室充盈受限模式进一步分为两组。所有患者均进行临床随访，记录事件（死亡或因心脏原因住院）。平均随访时间为682.2±55天。
患者的平均年龄为70.4±1.2岁；54.3%为女性；平均射血分数为49.6±1%；平均BNP水平为202.9±41.3 pg/ml。死亡率为19.6%，联合事件（死亡或因心脏原因住院）发生在26.1%的患者中。在临床、人口统计学、生化、超声心动图和神经体液参数中，只有BNP水平在总体人群中具有预后意义。在II组患者中，BNP水平、心率和左心室充盈受限模式被确定具有预后意义。Kaplan-Meier曲线分析表明，BNP和左心室充盈受限模式似乎都是重要的预后标志物。
这项初步研究表明，神经体液活动（由血浆BNP水平决定）和心室充盈受限模式可能是左心室收缩功能保留的心力衰竭患者预后分层的重要因素。
