失代偿性心力衰竭伴收缩功能障碍或收缩功能保留患者的临床特征及预后差异

[Differences in clinical profile and outcome in patients with decompensated heart failure and systolic dysfunction or preserved systolic function].

作者信息

Macín Stella M, Perna Eduardo R, Címbaro Canella Juan P, Alvarenga Pablo, Pantich Rolando, Ríos Nelson, Farías Eduardo F, Badaracco Jorge R

机构信息

Instituto de Cardiología Juana Francisca Cabral. Corrientes. Argentina.

出版信息

Rev Esp Cardiol. 2004 Jan;57(1):45-52.

DOI:

PMID:14746717

Abstract

OBJECTIVES

To compare the clinical characteristics and short- and long-term prognosis for chronic heart failure with left ventricular systolic dysfunction or preserved systolic function.

PATIENTS AND METHOD

Three-hundred twenty-eight consecutive patients with decompensated chronic heart failure were studied prospectively. Depending on ejection fraction, participants were classified as having systolic dysfunction (group 1, ejection fraction < or = 40%,) or preserved systolic function (group 2, ejection fraction >40%).

RESULTS

Systolic dysfunction was detected in 192 patients (58.5%) and preserved systolic function in 41.5%. Mean age was 62.7 (12.5 years) in group 1 and 65.2 (16.2 years) in group 2 (P=.03), with a male prevalence of 73.3% and 49.3%, respectively (P<.001). Ischemic cardiomyopathy was more frequent in group 1 (44.8% vs 25%; P<.001). Physical examination and electrocardiogram findings were similar in both groups, except for a higher proportion of patients in group 1 with a heart third sound (43.2% vs 25%; P=.001) and left bundle branch block (40.6% vs 15.4%; P<.001) and abnomal Q waves (31.3% vs 20.6%; P=.04). In-hospital mortality was similar in patients with systolic dysfunction and preserved systolic function (2.9% vs 1%; P=NS). Twenty-four-month cumulative survival was 61% for patients with systolic dysfunction and 76% for patients with preserved systolic function (log rank test P=NS). In the Cox proportional hazards model, which included age, sex, functional class, hepatomegaly, peripheral hypoperfusion, BUN, sodium level, ejection fraction > 40%, and biventricular heart failure, preserved systolic function was not associated with late mortality. The variables that were independent predictors of late mortality were peripheral hypoperfusion (OR = 3.7; P<.0001), low sodium level (OR=0.9; P=.009) and male sex (OR=1.9; P=.041).

CONCLUSIONS

Decompensated chronic heart failure with preserved systolic function was more frequent in women and older patients. Patients with preserved systolic function had a lower prevalence of coronary heart disease. However, these differences had no impact on the short- and long-term prognosis.

摘要

目的

比较左心室收缩功能障碍或收缩功能保留的慢性心力衰竭的临床特征及短期和长期预后。

患者与方法

对连续328例失代偿性慢性心力衰竭患者进行前瞻性研究。根据射血分数，参与者被分为收缩功能障碍组（第1组，射血分数≤40%）或收缩功能保留组（第2组，射血分数>40%）。

结果

192例患者（58.5%）检测到收缩功能障碍，41.5%患者收缩功能保留。第1组平均年龄为62.7岁（12.5岁），第2组为65.2岁（16.2岁）（P = 0.03），男性患病率分别为73.3%和49.3%（P < 0.001）。第1组缺血性心肌病更常见（44.8%对25%；P < 0.001）。两组体格检查和心电图结果相似，但第1组有第三心音的患者比例更高（43.2%对25%；P = 0.001）、左束支传导阻滞比例更高（40.6%对15.4%；P < 0.001）以及异常Q波比例更高（31.3%对20.6%；P = 0.04）。收缩功能障碍患者和收缩功能保留患者的院内死亡率相似（2.9%对1%；P = 无显著差异）。收缩功能障碍患者24个月累积生存率为61%，收缩功能保留患者为76%（对数秩检验P = 无显著差异）。在包含年龄、性别、功能分级、肝肿大、外周灌注不足、血尿素氮、钠水平、射血分数>40%和双心室心力衰竭的Cox比例风险模型中，收缩功能保留与晚期死亡率无关。晚期死亡率的独立预测变量为外周灌注不足（比值比 = 3.7；P < 0.0001）、低钠水平（比值比 = 0.9；P = 0.009）和男性（比值比 = 1.9；P = 0.041）。