摘要
目的探讨Selvester QRS评分在扩张型心肌病(DCM)患者左心室瘢痕和预后中的预测作用。方法入选2017年12月至2019年12月在雅安市人民医院心内科住院并完成随访的78例DCM患者,收集患者的相关临床资料,计算Selvester QRS评分和钆对比剂延迟增强-心脏磁共振(LGE-CMR)得分。随访主要观察不良心脏事件(心力衰竭再住院、致死性心律失常和心原性死亡)发生情况。结果随访24~36个月,中位随访时间29个月,Selvester QRS平均评分为7.2分,LGE-CMR平均得分为5.4%。Spearman相关性分析结果提示,LGE-CMR得分与Selvester QRS评分显著相关(P<0.001)。共发生34例(43.6%)不良心脏事件,其中12例(15.4%)心原性死亡,25例(32.1%)因心力衰竭加重再次住院,6例(7.7%)致死性心律失常。Selvester QRS评分(OR=2.388,95%CI:1.227~4.649,P<0.05)和LGE-CMR得分(OR=2.549,95%CI:1.340~4.848,P<0.01)是发生不良心脏事件的独立危险因素。LGE-CMR得分(OR=1.230,95%CI:1.074~1.409,P<0.01)是发生心原性死亡的独立危险因素。受试者工作特征曲线结果显示,Selvester QRS评分预测不良心脏事件的最佳临界值6.5分,灵敏度为97.1%,特异度为72.7%(AUC=0.934,P<0.001)。LGE-CMR得分预测不良心脏事件的最佳临界值4.5%,灵敏度为94.1%,特异度为97.7%(AUC=0.950,P<0.001)。Kaplan-Meier生存分析显示,Selvester QRS评分提示瘢痕≥6.5%的患者发生不良心脏事件的风险显著高于Selvester QRS评分提示瘢痕<6.5%的患者(P=0.013),且瘢痕的存在增加发生心原性死亡的风险(P=0.045)。结论Selvester QRS评分可评估DCM患者的左心室瘢痕情况,并可预测不良心脏事件的发生风险。
Objective To investigate the role of Selvester QRS score in predicting left ventricular scar and prognosis in patients with dilated cardiomyopathy(DCM).Methods The 78 DCM patients who were hospitalized and followed up in the Department of Cardiology of Ya’an People’s Hospital from December 2017 to December 2019 were selected.Relevant clinical data were collected,and the Selvester QRS score and late gadolinium enhancement-cardiac magnetic resonance(LGE-CMR)were calculated.The main follow-up was to observe the occurrence of adverse cardiac events(rehospitalization of heart failure,fatal arrhythmia and cardiac death).Results With a median follow-up of 29(24-36)months,the average score of Selvester QRS was 7.2,and the average score of LGE-CMR was 5.4%.Spearman correlation analysis showed that LGE-CMR score and Selvester QRS score were significantly correlated(P<0.001).There were 34 cases(43.6%)of cardiac events,including 12 cases(15.4%)of cardiac death,25 cases(32.1%)of rehospitalization due to aggravation of heart failure,and 6 cases(7.7%)of fatal arrhythmia.Multivariate analysis of cardiac events showed that Selvester QRS score(OR=2.388,95%CI:1.227-4.649,P<0.05)and LGE-CMR score(OR=2.549,95%CI:1.340-4.848,P<0.01)were independent risk factors associated with cardiac events in patients with DCM.Multivariate analysis of cardiac death showed that LGE-CMR score(OR=1.230,95%CI:1.074-1.409,P<0.01)was an independent risk factor for cardiac death in patients with DCM.The ROC analysis of Selvester QRS score as a predictor of cardiac events in patients with DCM showed that the optimal critical value was 6.5 points,the sensitivity was 97.1%,and the specificity was 72.7%(area under the curve was 0.934,P<0.001).ROC analysis using LGE-CMR to quantify scars to predict cardiac events in patients with DCM showed that the optimal threshold value was 4.5%,the sensitivity was 94.1%,and the specificity was 97.7%(area under the curve was 0.950,P<0.001).Kaplan Meier survival analysis showed that the incidence of cardiac events predicted by Selvester QRS score with scar≥6.5%was significantly higher than that predicted by Selvester QRS score with scar<6.5%(log-rank P=0.013).Using LGE-CMR based scar calculations,it was shown that the presence of scars increased the risk of cardiac death(log-rank P=0.045).Conclusions Selvester QRS score can evaluate left ventricular scar and predict future cardiac events in patients with DCM.
作者
吴鹏
任平
张海波
陈元国
赵鑫
杜雪
周梦迪
罗士喜
Wu Peng;Ren Ping;Zhang Haibo;Chen Yuanguo;Zhao Xin;Du Xue;Zhou Mengdi;Luo Shixi(Department of Cardiology,Ya’an People’s Hospital,Ya’an 625000,China)
出处
《中国心血管杂志》
2022年第5期434-440,共7页
Chinese Journal of Cardiovascular Medicine
基金
四川省卫生和计划生育委员会科研课题(普及应用项目)(17PJ015)
四川省医学科研课题(S17077)。
