超声心动图心肌能量消耗评价射血分数保留的心力衰竭患者的预后价值
|
摘要
目的:探讨超声心动图测量心肌能量消耗(MEE)在射血分数保留的心力衰竭(HFpEF)患者中的应用。方法:选择2017-06-2018-06入我院诊断为HFpEF的患者共80例,作为观察组;另选择50例健康体检者作为对照组;采用超声心动图测量MEE和左室射血分数(LVEF),ELISA法检测血清脑钠肽前体(pro-BNP)水平;随访6.0个月,将患者分为主要心脏不良事件(MACEs)组和无MACEs组,采用多因素Logistic回归分析筛选影响MACEs的因素。结果:观察组MEE水平显著高于对照组(P<0.05)。Pearson相关分析得出,MEE与LVEF呈负相关(r=-0.568),与pro-BNP呈正相关(r=0.623)。观察组共10例发生MACEs(12.5%),Logistic回归分析得出,MEE、LVEF和pro-BNP均是影响MACEs发生的独立危险因素(P<0.05)。结论:超声心动图测量MEE无创伤、准确性高、重复性好,在HFpEF患者中与LVEF和pro-BNP有较好的相关性,对预测MACEs发生也有重要的应用价值。
Objective:To evaluate myocardial energy expenditure(MEE) measured by echocardiography in patients of heart failure with preserved ejection fraction(HFpEF) and the correlation to the prognosis.Method:A total of 80 consecutives as HFpEF from June 2017 to June 2018 in observation group and other 50 healthy persons in control group were enrolled.Then we measured MEE and left ventricular ejection fraction(LVEF) by echocardiography,serum pro-BNP level by ELISA.We analyzed correlation between MEE and LVEF or pro-BNP,and divided them in observation group to major adverse cardiac events(MACEs) group and non-MACEs group after 6.0 months follow-up.We scaned the possible factors to MACEs occurring in HFPEF patients by multivariate logistic regression analysis.Result:The MEE value in observation group was significantly higher than control group(P<0.05).It was negative to MEE and LVEF(r=-0.568),while positive to pro-BNP(r=0.623)by correlation analysis.There were 10 cases induced MACEs(12.5%).MEE,LVEF and pro-BNP were all the independent risk factors to MACEs by logistic regression analysis(P<0.05).Conclusion:There is a better correlation between MEE and LVEF or pro-BNP in HFpEF patients,which is better prediction of MACEs.
Objective:To evaluate myocardial energy expenditure(MEE) measured by echocardiography in patients of heart failure with preserved ejection fraction(HFpEF) and the correlation to the prognosis.Method:A total of 80 consecutives as HFpEF from June 2017 to June 2018 in observation group and other 50 healthy persons in control group were enrolled.Then we measured MEE and left ventricular ejection fraction(LVEF) by echocardiography,serum pro-BNP level by ELISA.We analyzed correlation between MEE and LVEF or pro-BNP,and divided them in observation group to major adverse cardiac events(MACEs) group and non-MACEs group after 6.0 months follow-up.We scaned the possible factors to MACEs occurring in HFPEF patients by multivariate logistic regression analysis.Result:The MEE value in observation group was significantly higher than control group(P<0.05).It was negative to MEE and LVEF(r=-0.568),while positive to pro-BNP(r=0.623)by correlation analysis.There were 10 cases induced MACEs(12.5%).MEE,LVEF and pro-BNP were all the independent risk factors to MACEs by logistic regression analysis(P<0.05).Conclusion:There is a better correlation between MEE and LVEF or pro-BNP in HFpEF patients,which is better prediction of MACEs.
引文
[1] 陈宏,周鹏,侯霁芯,等.射血分数保留心力衰竭的临床特征及预后因素分析[J].临床心血管病杂志,2018,34(10):1018-1023.
[2] 谢祥琨,许顶立.射血分数保留心力衰竭的治疗探索[J].临床心血管病杂志,2018,34(10):1032-1036.
[3] 安冬琪,许顶立.心肌能量代谢测量的临床应用进展[J].中华老年心脑血管病杂志,2017,19(7):765-768.
[4] Taegtmeyer H,Young ME,Lopaschuk GD,et al.Assessing cardiac metabolism:a scientific statement from the american heart association[J].Circ Res,2016,118(10):1659-1701.
[5] 朱达,彭映辉.VFM技术在评估扩张性心肌病患者左室腔内血流能量损耗中的应用[J].实用医学杂志,2018,34(5):800-805.
[6] 马荣川,尹立雪,汪智慧,等.超声血流向量成像技术评价2型糖尿病患者左心室舒张期能量损耗[J].中华医学超声杂志(电子版),2016,13(3):178-184.
[7] 张鹏,艾力曼·马合木提,孙娟.心肌能量代谢与慢性心力衰竭心室重构关系及心肌能量代谢药物应用的研究进展[J].中华实用诊断与治疗杂志,2018,32(1):94-97.
[8] Chen P,Zhan Q,Bai Y,et al.Serum peroxisome proliferator-activated receptor gamma coactivator-1α related to myocardial energy expenditure in patients with chronic heart failure[J].Am J Med Sci,2019,357(3):205-212.
[9] Cetin MS,Ozcan Cetin EH,Canpolat U,et al.Prognostic significance of myocardial energy expenditure and myocardial efficiency in patients with heart failure with reduced ejection fraction[J].Int J Cardiovasc Imaging,2018,34(2):211-222.
[10] Zhao Z,Luo J,Ma L,et al.Effect of granulocyte colony stimulating EPC on cardiac function and myocardial energy expenditure in patients with heart failure after myocardial infarction[J].Int J Clin Exp Med,2015,8(9):16578-16584.
[11] 李学远,田政球,程文林.曲美他嗪对不同病因心力衰竭病人心肌能量消耗及心室重塑的影响[J].中西医结合心脑血管病杂志,2017,15(20):2589-2592.
[12] Goldenthal MJ.Mitochondrial involvement in myocyte death and heart failure[J].Heart Fail Rev,2016,21(2):137-155.
[13] 凌洋,李竹琴.优化心肌代谢治疗心力衰竭的研究进展[J].医学研究杂志,2016,45(10):168-171.
[14] 余怡文,张荣成.左卡尼汀在心力衰竭中的临床应用进展[J].心血管病学进展,2017,38(4):403-407.
[15] 曹玉坤,崔越,史河水.心脏磁共振技术评价糖尿病心肌病的研究进展[J].临床心血管病杂志,2018,34(8):817-822.
[16] 龙骁,陈然,程春,等.AMI后心力衰竭应用不同剂量培哚普利的疗效及对NT-pro BNP及心肌能量消耗的影响[J].中国临床研究,2017,30(6):740-743.
[2] 谢祥琨,许顶立.射血分数保留心力衰竭的治疗探索[J].临床心血管病杂志,2018,34(10):1032-1036.
[3] 安冬琪,许顶立.心肌能量代谢测量的临床应用进展[J].中华老年心脑血管病杂志,2017,19(7):765-768.
[4] Taegtmeyer H,Young ME,Lopaschuk GD,et al.Assessing cardiac metabolism:a scientific statement from the american heart association[J].Circ Res,2016,118(10):1659-1701.
[5] 朱达,彭映辉.VFM技术在评估扩张性心肌病患者左室腔内血流能量损耗中的应用[J].实用医学杂志,2018,34(5):800-805.
[6] 马荣川,尹立雪,汪智慧,等.超声血流向量成像技术评价2型糖尿病患者左心室舒张期能量损耗[J].中华医学超声杂志(电子版),2016,13(3):178-184.
[7] 张鹏,艾力曼·马合木提,孙娟.心肌能量代谢与慢性心力衰竭心室重构关系及心肌能量代谢药物应用的研究进展[J].中华实用诊断与治疗杂志,2018,32(1):94-97.
[8] Chen P,Zhan Q,Bai Y,et al.Serum peroxisome proliferator-activated receptor gamma coactivator-1α related to myocardial energy expenditure in patients with chronic heart failure[J].Am J Med Sci,2019,357(3):205-212.
[9] Cetin MS,Ozcan Cetin EH,Canpolat U,et al.Prognostic significance of myocardial energy expenditure and myocardial efficiency in patients with heart failure with reduced ejection fraction[J].Int J Cardiovasc Imaging,2018,34(2):211-222.
[10] Zhao Z,Luo J,Ma L,et al.Effect of granulocyte colony stimulating EPC on cardiac function and myocardial energy expenditure in patients with heart failure after myocardial infarction[J].Int J Clin Exp Med,2015,8(9):16578-16584.
[11] 李学远,田政球,程文林.曲美他嗪对不同病因心力衰竭病人心肌能量消耗及心室重塑的影响[J].中西医结合心脑血管病杂志,2017,15(20):2589-2592.
[12] Goldenthal MJ.Mitochondrial involvement in myocyte death and heart failure[J].Heart Fail Rev,2016,21(2):137-155.
[13] 凌洋,李竹琴.优化心肌代谢治疗心力衰竭的研究进展[J].医学研究杂志,2016,45(10):168-171.
[14] 余怡文,张荣成.左卡尼汀在心力衰竭中的临床应用进展[J].心血管病学进展,2017,38(4):403-407.
[15] 曹玉坤,崔越,史河水.心脏磁共振技术评价糖尿病心肌病的研究进展[J].临床心血管病杂志,2018,34(8):817-822.
[16] 龙骁,陈然,程春,等.AMI后心力衰竭应用不同剂量培哚普利的疗效及对NT-pro BNP及心肌能量消耗的影响[J].中国临床研究,2017,30(6):740-743.