超声心动图在老年高血压射血分数保留型心力衰竭临床诊断及预后评估中的应用价值

摘要
图/表
参考文献
相关文章 (6)

全文:PDF(2242 KB)HTML(1 KB)
输出:BibTeX|EndNote(RIS)

摘要目的：观察超声心动图在老年高血压射血分数保留型心力衰竭（HFpEF）临床诊断及预后评估中的应用价值。方法：选取2020年1月―2023年4月我院收治的196例老年高血压患者为研究对象,根据是否合并HFpEF,将合并HFpEF患者纳入研究组（n=96）,不合并HFpEF患者纳入对照组（n=100）,比较两组超声心动图参数,采用受试者工作特征（ROC）曲线分析其对高血压HFpEF的临床诊断价值。根据患者出院后3个月内是否发生主要不良心血管事件（MACE）将研究组患者分为预后良好组与预后不良组,探究患者预后的影响因素。结果：研究组患者超声心动图参数中舒张期室间隔厚度（IVSTD）、舒张期左心室内径（LVDd）、舒张期左心室后壁厚度（LVPWTD）及左室心肌质量指数（LVMI）均高于对照组。ROC特征曲线结果显示,IVSTD诊断高血压HFpEF的最佳截断值为0.985 mm,LVDd最佳截断值为4.085 mm,LVPWTD最佳截断值为0.965 mm,LVMI最佳截断值为114.175 g/m²,且四者联合诊断高血压HFpEF的AUC及敏感度均高于单一指标预测。预后不良组患者血红蛋白（Hb）水平及左室射血分数（LVEF）低于预后良好组,心功能分级、LVMI及心肌能量消耗（MEE）高于预后良好组,且多因素Logistic回归分析结果显示,Hb、心功能分级、LVEF及MEE是高血压HFpEF患者预后水平的独立影响因素。结论：与不合并HFpEF老年高血压患者比较,老年高血压合并HFpEF患者超声心动图参数中IVSTD、LVDd、LVPWTD及LVMI更高,且四项指标联合诊断高血压HFpEF的应用价值较高,同时Hb、心功能分级、LVEF及MEE是高血压HFpEF患者预后的独立影响因素,建议临床予以重点关注。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	何谦
	徐可
	杨雅兰
	周春美
	刘家开
	杜镇鸿

关键词：超声心动图,高血压,射血分数保留型心力衰竭,临床诊断,预后评估

Abstract：ObjectiveTo evaluate the application value of echocardiography in clinical diagnosis and prognosis evaluation of heart failure with preserved ejection fraction（HFpEF）in elderly patients with hypertension.MethodsA total of 96 elderly hypertension with HFpEF patients who were admitted to the hospital from January 2020 to April 2023 were selected as the study subjects. Among them,patients with HFpEF were included in the study group（n=96）and those without HFpEF were included in the control group（n=100）. The echocardiographic parameters of the two groups were compared,and the clinical value of echocardiography in diagnosing hypertension and HFpEF was analyzed using the receiver operating characteristic（ROC）curve. Patients in the study group were divided into the good prognosis group and the poor prognosis group according to the presence or absence of major adverse cardiovascular events（MACE）within 3 months after discharge. The prognostic factors were explored.ResultsIVSTD,LVDd,LVPWTD and LVMI in the study group were higher than those in the control group. ROC curve analysis found that the optimal cutoff values of IVSTD,LVDd,LVPWTD and LVMI for diagnosing hypertension and HFpEF were 0.985 mm,4.085 mm,0.965 mm and 114.175 g/m²,respectively. The AUC and sensitivity of the combined diagnosis of hypertension and HFpEF were higher than those of single diagnosis. Hb level and LVEF in the poor prognosis group were lower than those in the good prognosis group. The grade of cardiac function,LVMI and MEE were higher than those in the good prognosis group. Multivariate logistic regression analysis found that Hb,the grade of cardiac function,LVEF,and MEE were independent influencing factors for the prognosis of hypertension and HFpEF.ConclusionCompared with elderly hypertension patients without HFpEF,elderly hypertension with HFpEF patients have larger IVSTD,LVDd,LVPWTD and LVMI. The combination of these four indicators is of high application value in diagnosing hypertension with HFpEF. Hb,the grade of cardiac function,LVEF,and MEE are independent prognostic factors in hypertension with HFpEF patients,which deserves special attention in clinical practice.

Key words：echocardiography hypertension heart failure with preserved ejection fraction clinical diagnosis prognosis evaluation

收稿日期:2023-08-29

中图分类号:

R541

基金资助:四川省干部保健科研课题（川干研2021-201）

通讯作者:何谦,E-mail：13550043072@163.com

引用本文:

何谦, 徐可, 杨雅兰, 周春美, 刘家开, 杜镇鸿. 超声心动图在老年高血压射血分数保留型心力衰竭临床诊断及预后评估中的应用价值[J]. 金宝搏官方188学报(医学版), 2023, 20(5): 65-69. HE Qian, XU Ke, YANG Yalan, ZHOU Chunmei, LIU Jiakai, DU Zhenhong. Application value of echocardiography in clinical diagnosis and prognosis evaluation of heart failure with preserved ejection fraction in elderly patients with hypertension. HuNan ShiFan DaXue XueBao(YiXueBan), 2023, 20(5): 65-69.

链接本文:

http://yxb.hunnu.edu.cn/CN/或http://yxb.hunnu.edu.cn/CN/Y2023/V20/I5/65

[1] Casebeer A,Horter L,Hayden J,et al.Phenotypic clustering of heart failure with preserved ejection fraction reveals different rates of hospitalization[J]. J Cardiovasc Med,2021,22(1):45-52.
[2] 张铭炀,王佐翔,顾怡钰,等. 基于老年营养风险指数构建老年射血分数保留型心力衰竭患者的预后模型[J]. 中国医药导报,2022,19(29):29-33.
[3] Woolley RJ,Ceelen D,Ouwerkerk W,et al.Machine learning based on biomarker profiles identifies distinct subgroups of heart failure with preserved ejection fraction[J]. Eur J Heart Fail,2021,23(6):983-991.
[4] 黄鑫涛,白保强,李之恒,等. 不同剂量瑞舒伐他汀对老年高血压并射血分数保留型慢性心力衰竭患者心室重构的影响[J]. 重庆医科大学学报,2022,47(1):66-73.
[5] Fauchier L,Bodin A,Bisson A.Beta-Blocker Withdrawal and Chronotropic Incompetence in Heart Failure With Preserved Ejection Fraction[J]. J Am Coll Cardiol,2022,79(9):e195.
[6] 张铭瑞,崔雯霞,高蕾,等. 老年高血压病人合并射血分数保留的心力衰竭的临床特征及相关危险因素分析[J]. 实用老年医学,2022,36(12):1247-1250.
[7] Arora R,Sethuraman U,Merolla D,et al.Efficacy of Biomarkers in Identifying Abnormal Echocardiogram in Multisystem Inflammatory Syndrome in Children[J]. Clin Pediatr,2023,62(8):908-913.
[8] 黄震华. 世界卫生组织和国际高血压联盟颁布新的高血压治疗指南[J]. 中国新药与临床杂志,1999,18(3):190.
[9] 刘蔚,尉然. 射血分数保留的心力衰竭的诊断和治疗策略[J]. 中国全科医学,2021,24(3):253-258.
[10] 刘朝阳,吴小雷,鲁大胜,等. 血清8-OHdG联合动态动脉僵硬指数对高血压伴慢性心力衰竭患者主要不良心血管事件的预测价值[J]. 疑难病杂志,2023,22(8):785-790.
[11] 宋婷婷,刘丽,付志强,等. H型高血压合并射血分数保留心衰患者血压昼夜节律与阵发性心房颤动的相关性[J]. 金宝搏官方188学报(医学版),2021,18(4):79-82.
[12] Steding-Ehrenborg K,Hedstrm E,Carlsson M,et al.Hydraulic force is a novel mechanism of diastolic function that may contribute to decreased diastolic filling in HFpEF and facilitate filling in HFrEF[J]. J Appl Physiol,2021,130(4):993-1000.
[13] 黄鑫涛,白保强,李之恒,等. 不同剂量瑞舒伐他汀对老年高血压并射血分数保留型慢性心力衰竭患者心室重构的影响[J]. 重庆医科大学学报,2022,47(1):66-73.
[14] Kittleson MM,Panjrath GS,Amancherla K,et al.2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction:A Report of the American College of Cardiology Solution Set Oversight Committee[J]. J Am Coll Cardiol,2023,81(18):1835-1878.
[15] Tian LJ,Duan F,Li XH,et al.Incidence,risk factors and prognostic effect of imaging left ventricular diastolic dysfunction in patients with COVID-19:protocol for a systematic review[J]. BMJ open,2022,12(4):e059281.
[16] 蒋殿虎,陈志旺,白书昌,等. 不同左心室舒张末压慢性射血分数保留性心力衰竭患者超声心动图参数差异分析[J]. 中国医学物理学杂志,2021,38(5):596-601.
[17] 吴巧,陈宇,陈丽,等. 射血分数保留的心力衰竭患者心肌能量消耗情况及预后不良的相关因素[J]. 分子影像学杂志,2022,45(2):239-243.
[18] 朱剑,边素艳,刘姗姗,等. 老年射血分数保留的心力衰竭合并贫血患者心脏结构及功能分析[J]. 中华老年多器官疾病杂志,2023,22(1):19-23.