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

Evaluation value of left atrial function in long-term prognosis of elderly patients with ischemic cardiomyopathy after coronary artery bypass grafting

中文关键词: 老年  缺血性心肌病  心脏磁共振  心房功能  冠脉搭桥

英文关键词: elderly  ischemic cardiomyopathy  cardiac magnetic resonance  atrial function  coronary artery bypass grafting

中文摘要:

      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/m2 组和LAEFreser-voir＜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.

英文摘要:

      Objective To investigate the value of left atrial function in evaluating the long-term prognosis of elderly pa-tients 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 under-went CABG in Fuwai Hospital from January 2012 to January 2017 were selected as the study subjects.Their median follow-up time was63.8 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 be-tween 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 maxi-mal 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/m2 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.