摘要
目的研究左房功能对老年缺血性心肌病患者冠脉搭桥术后远期预后的评估价值。方法选取2012年1月—2017年1月在阜外医院行冠脉搭桥手术,并术前完善心脏磁共振检查左室射血分数≤35%的老年缺血性心肌病患者131例作为研究对象,中位随访时间63.8个月。根据是否发生主要终点事件(MACE),分为MACE组和无MACE组,比较2组患者基线特征、心脏磁共振参数。生存分析采用Kaplan-Meier曲线,生存率比较采用Log-rank检验。采用多变量COX回归分析评估老年缺血性心肌病患者发生主要终点事件的危险因素。结果MACE组最大左房容积指数(LAVmax/BSA)高于无MACE组,左房储存期射血分数(LAEFreservoir)、左房泵血期射血分数(LAEFpump)均低于无MACE组,差异均有统计学意义(P<0.05)。Kaplan-Meier生存曲线分析结果显示,LAVmax/BSA≥46.72 mL/m 2组和LAEFreservoir<29.94%组无事件生存率较低(P<0.05)。多变量COX回归分析显示,LAEFreservoir[HR 0.964;95%CI(0.94,0.989),P=0.006]与老年缺血性心肌病患者冠脉搭桥术后远期主要终点事件独立相关。结论LAEFreservoir是老年缺血性心肌病患者冠脉搭桥术后远期主要终点事件的独立预测因子。
Objective To investigate the value of left atrial function in evaluating the long-term prognosis of elderly patients with ischemic cardiomyopathy(ICM)after coronary artery bypass grafting(CABG).Methods 131 elderly patients with ICM who received pre-operation cardiac magnetic resonance examination with left ventricular ejection fraction≤35%and underwent CABG in Fuwai Hospital from January 2012 to January 2017 were selected as the study subjects.Their median follow-up time was 63.8 months.According to whether the major adverse cardiovascular events(MACE)occurred,they were divided into MACE group and non-MACE group.The baseline characteristics and cardiac magnetic resonance parameters were compared between the two groups.Kaplan-Meier curve was used for survival analysis,and Log-rank test was used for survival comparison.Multivariate COX regression analysis was used to evaluate risk factors for MACE in elderly ICM patients.Results The maximal left atrial volume index(LAVmax/BSA)of the MACE group was higher than that of the non-MACE group,and the left atrial ejection fraction of reservoir(LVEFreservoir)and left atrial ejection fraction of pump(LAEFpump)were lower than those of the non-MACE group,with statistical significance(P<0.05).The Kaplan-Meier survival curve analysis showed that there was a statistically significant decrease in event free survival rates(P<0.05)in the LAVmax/BSA≥46.72 mL/m 2 group and the LAEFreservoir<29.94%group.Multivariate COX regression analysis showed that LAEFreservoir[HR 0.964;95%CI(0.94,0.989),P=0.006]was independently associated with the long-term MACE after CABG in elderly ICM patients.Conclusion LAEFreservoir is an independent predictor of long-term MACE in elderly ICM patients after CABG.
作者
刘千军
周迪
董影
杨滔
宋卫香
袁勇
尹刚
赵世华
曲新凯
陆敏杰
Liu Qianjun;Zhou Di;Dong Ying;Yang Tao;Song Weixiang;Yuan Yong;Yin Gang;Zhao Shihua;Qu Xinkai;Lu Minjie(Department of Cardiology,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China;Department of Magnetic Resonance Imaging,Fuwai Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing,100037,P.R.China;Department of Imaging,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China;Department of Cardiac Surgery,Fuwai Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing,100037,P.R.China;Department of Radiology,Second Affiliated Hospital of Chongqing Medical University,Chongqing,400010,P.R.China;Department of Radiology,Geriatric Hospital Affiliated to Nanjing Medical University,Nanjing,210024,P.R.China)
出处
《老年医学与保健》
CAS
2024年第2期297-303,309,共8页
Geriatrics & Health Care
基金
国家自然科学基金(81971588)
中国医学科学院临床与转化医学研究基金(2019XK320063)
中国医学科学院中央级公益性科研院所基本科研业务费项目(2019PT310025)。
关键词
老年
缺血性心肌病
心脏磁共振
心房功能
冠脉搭桥
elderly
ischemic cardiomyopathy
cardiac magnetic resonance
atrial function
coronary artery bypass grafting
