左心室充盈模式受限和左心房前后径增加：慢性心力衰竭II级纽约心脏协会（NYHA）分级患者临床病情恶化的两个可靠预测指标。

Restrictive left ventricular filling pattern and increase in antero-posterior left atrial diameter: two reliable predictors of clinical deterioration in chronic heart failure II NYHA class patients.

作者信息

De Vecchis Renato, Cioppa Carmela, Giasi Anna, Pucciarelli Armando, Cantatrione Salvatore

机构信息

Cardiology Unit, Presidio Sanitario Intermedio Elena d' Aosta, Naples, Italy.

出版信息

Anadolu Kardiyol Derg. 2009 Oct;9(5):364-70.

PMID:19819786

Abstract

OBJECTIVE

To identify the Doppler echocardiographic criteria able to predict clinical deterioration of mild-to- moderate chronic heart failure (CHF) as well as, whenever possible, to evaluate the features of chronological relation of cavitary remodelling in left chambers during follow-up (FU).

METHODS

A retrospective, case-controlled study, including a number of CHF II NYHA class patients, was carried out, to evaluate, by means of univariate and multivariable logistic regression analyses, the role as predictor of CHF worsening of some Doppler echocardiographic parameters, listed as follows: left ventricular mass index, analyzed both as continuous and as dichotomous (>130 g/m2) variable; left ventricular end-systolic volume (LVESV) >57 ml; left ventricular ejection fraction (LVEF), divided into 2 classes: a) LVEF>45%, i.e. normal or mildly impaired LVEF, and 2) reduced (45%-30%) LVEF; restrictive left ventricular filling pattern (RFP); antero-posterior left atrial diameter (LADi) >50 mm; ratio of early mitral inflow to early myocardial velocity>8.

RESULTS

Of 173 patients enrolled, 60 patients (15 cases of transition to III NYHA class and 45 controls) were included in retrospective analysis. At univariate analysis, RFP and LADi>50 mm were shown to be associated with worsening of CHF. At multivariate analysis, the role of prognostic indicator of poor outcome was maintained by RFP (OR=17.0, 95%CI: 2.5-116.5) as well as by LADi>50 mm (OR=7.95, 95%CI: 1.27.0-49.6). On the other hand, in the subset of CHF with LVEF >45%, increased LADi was not associated with occurrence of increase in LVESV or left ventricular progressive dilation during the subsequent follow-up.

CONCLUSIONS

In mild-to-moderate CHF, RFP and LADi>50 mm are predictors of adverse outcome, independently of the presence or severity of left ventricular systolic dysfunction.

摘要

目的

确定能够预测轻至中度慢性心力衰竭（CHF）临床恶化的多普勒超声心动图标准，并在可能的情况下，评估随访（FU）期间左心腔空洞重塑的时间关系特征。

方法

开展一项回顾性病例对照研究，纳入一定数量纽约心脏病协会（NYHA）II级CHF患者，通过单变量和多变量逻辑回归分析，评估以下列出的一些多普勒超声心动图参数作为CHF恶化预测指标的作用：左心室质量指数，作为连续变量和二分变量（>130 g/m²）进行分析；左心室收缩末期容积（LVESV）>57 ml；左心室射血分数（LVEF），分为2类：a）LVEF>45%，即LVEF正常或轻度受损，以及2）降低（45%-30%）的LVEF；限制性左心室充盈模式（RFP）；左心房前后径（LADi）>50 mm；二尖瓣早期血流与早期心肌速度比值>8。

结果

在纳入的173例患者中，60例患者（15例转变为NYHA III级的病例和45例对照）纳入回顾性分析。单变量分析显示，RFP和LADi>50 mm与CHF恶化相关。多变量分析中，RFP（OR=17.0，95%CI：2.5-116.5）以及LADi>50 mm（OR=7.95，95%CI：1.27.0-49.6）维持了不良结局预后指标的作用。另一方面，在LVEF>45%的CHF亚组中，LADi增加与随后随访期间LVESV增加或左心室进行性扩张的发生无关。