[高血压性扩张型心肌病合并慢性心力衰竭患者收缩功能障碍的临床结局及可逆性]

[Clinical outcome and reversibility of systolic dysfunction in patients with dilated cardiomyopathy due to hypertension and chronic heart failure].

作者信息

Anguita Sánchez Manuel, Rodríguez Esteban Marcos, Ojeda Pineda Soledad, Ruiz Ortiz Martín, Romo Peña Elías, Mesa Rubio Dolores, Vallés Belsué Federico

机构信息

Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain.

出版信息

Rev Esp Cardiol. 2004 Sep;57(9):834-41.

DOI:

PMID:15373989

Abstract

INTRODUCTION AND OBJECTIVES

There is little information on the clinical and functional course of patients with heart failure secondary to dilated cardiomyopathy due to hypertension. The objectives of our study were to assess the clinical and functional course of these patients, and to identify possible predictors of prognosis.

PATIENTS AND METHOD

We evaluated a series of 49 patients with this condition diagnosed in our hospital from 1994 to 2003. Mean age was 63(11) years, and 40% were women. Left ventricular ejection fraction was 30.1(4.8)%. Follow-up was 45(23) months (median, 41 months).

RESULTS

Four-year survival was 0.84, the 4-year rate of hospitalization due to heart failure was 0.12, and likelihood of readmission-free survival was 0.80 at 4 years. Left ventricular ejection fraction increased from 30.1(4.8)% to 57.6(13.5)% (P< .001). An unfavorable clinical and functional outcome at 4 years (death, readmission for heart failure or persistence of dilated cardiomyopathy) was recorded in only in 40% of the patients. Multivariate analysis with the Cox model showed appropriate control of blood pressure to be the only independent predictor of a favorable clinical outcome (absence of death or readmission for heart failure) (hazard ratio = 4.58; 95% CI, 1.32-9.83; P=.032).

CONCLUSIONS

The course of patients with severe dilated cardiomyopathy due to hypertension was favorable in 60% of cases. Adequate control of blood pressure was the only independent predictor of a favorable clinical outcome.

摘要

引言与目的

关于高血压所致扩张型心肌病继发心力衰竭患者的临床及功能病程，相关信息较少。我们研究的目的是评估这些患者的临床及功能病程，并确定可能的预后预测因素。

患者与方法

我们评估了1994年至2003年在我院诊断为此病的49例患者。平均年龄为63（11）岁，40%为女性。左心室射血分数为30.1（4.8）%。随访时间为45（23）个月（中位数为41个月）。

结果

4年生存率为0.84，4年因心力衰竭住院率为0.12，4年无再入院生存率为0.80。左心室射血分数从30.1（4.8）%增至57.6（13.5）%（P <.001）。仅40%的患者在4年时出现不良临床及功能结局（死亡、因心力衰竭再次入院或扩张型心肌病持续存在）。采用Cox模型进行多因素分析显示，血压得到适当控制是良好临床结局（无死亡或因心力衰竭再次入院）的唯一独立预测因素（风险比 = 4.58；95%置信区间，1.32 - 9.83；P =.032）。