酒精性心肌病在部落和非部落人群中的临床特征和预后因素。

Clinical profile and prognostic factors of alcoholic cardiomyopathy in tribal and non-tribal population.

机构信息

Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.

Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

出版信息

Open Heart. 2020 Nov;7(2). doi: 10.1136/openhrt-2020-001335.

DOI:10.1136/openhrt-2020-001335

PMID:33234711

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7689074/

Abstract

OBJECTIVE

Alcoholic cardiomyopathy (ACM) is a leading cause of non-ischaemic dilated cardiomyopathy (DCM) in tribal and non-tribal population. However, no study has been done depicting the correlation between clinical profile and prognosis of ACM in tribal and non-tribal population. This study also defines the long-term outcome and prognostic markers of ACM.

METHODS

We studied 290 patients with ACM who were evaluated in our institute between January 2013 and December 2016. The primary endpoint of the study was all-cause mortality. Statistical analysis was done by using Kaplan-Meier survival curves for the assessment of all-cause mortality and Cox regression for the assessment of risk factors.

RESULTS

After a median follow-up period of 3.75 years (IQR: 3-4 years), 50 patients with ACM (37.3%) died among tribal population while 14 patients (9%) died among non-tribal population. Independent predictors of all-cause mortality in ACM identified by Cox regression were left ventricular ejection fraction (LVEF) (HR: 0.883; 95% CI 0.783 to 0.996; p=0.043), QRS duration (HR: 1.010; 95% CI 1.007 to 1.017; p=0.005) and Child-Turcotte-Pugh (CTP) Scoring (HR: 12.332; 95% CI 6.999 to 21.728; p<0.001) at admission. The Kaplan-Meier survival probability estimate was 95.1% at 1 year and all-cause mortality was found to be higher in patients with QRS>120 ms, LVEF ≤35%, CTP Grade B/C than patients with QRS≤120 ms, LVEF >35% and CTP Score A, respectively (log-rank χ²=55.088, p<0.001; log-rank χ²=32.953, p<0.001; log-rank χ²=139.764, p<0.001, respectively).

CONCLUSION

Our study indicated increased morbidity and mortality in tribal population. LVEF, QRS duration and CTP Scoring at the time of presentation were found to be the independent prognostic markers of patients with ACM.

摘要

目的

酒精性心肌病（ACM）是非缺血性扩张型心肌病（DCM）在部落和非部落人群中的主要病因。然而，目前尚无研究描述部落和非部落人群中 ACM 的临床特征与预后之间的相关性。本研究还定义了 ACM 的长期结局和预后标志物。

方法

我们研究了 2013 年 1 月至 2016 年 12 月在我院接受评估的 290 例 ACM 患者。研究的主要终点是全因死亡率。采用 Kaplan-Meier 生存曲线评估全因死亡率，采用 Cox 回归评估危险因素。

结果

中位随访 3.75 年后（IQR：3-4 年），部落人群中有 50 例（37.3%）ACM 患者死亡，而非部落人群中有 14 例（9%）ACM 患者死亡。Cox 回归分析确定的 ACM 全因死亡的独立预测因素包括左心室射血分数（LVEF）（HR：0.883；95%CI：0.783 至 0.996；p=0.043）、QRS 持续时间（HR：1.010；95%CI：1.007 至 1.017；p=0.005）和入院时的 Child-Turcotte-Pugh（CTP）评分（HR：12.332；95%CI：6.999 至 21.728；p<0.001）。Kaplan-Meier 生存概率估计在 1 年内为 95.1%，发现 QRS>120ms、LVEF≤35%、CTP 分级 B/C 的患者全因死亡率高于 QRS≤120ms、LVEF>35%和 CTP 评分 A 的患者（log-rank χ²=55.088，p<0.001；log-rank χ²=32.953，p<0.001；log-rank χ²=139.764，p<0.001，分别）。