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目的:探讨急性心力衰竭(心衰)患者急性期室性期前收缩(室早)的数量及性质对于长期预后及危险分层评估的临床价值。方法:对从2012-03-2015-02共入组230例急性心衰患者随访18个月后,分析死亡组和非死亡组各项临床指标以及室早的数量及性质,对急性心衰患者长期预后的影响。终点事件定义为全因死亡。结果:室早总数(P=0.005)、多形性室早(P=0.03)与急性心衰患者18个月的死亡风险相关,而非持续性室性心动过速与急性心衰患者18个月死亡风险无明显相关性。多因素COX回归模型发现急性心衰患者急性期室早总数(HR1.193,P=0.04)、NT-proBNP、血钠及收缩压是全因死亡的独立预测因子。ROC曲线示室早总数曲线下面积(AUC)为0.642,最佳预测值为1 193次/24h,敏感性53.7%,特异性73.6%。Kaplan-Meier生存曲线显示频发多形性室早患者全因死亡率更高。结论:急性心衰患者急性期室早数量作为长期预后及危险分层的预测指标,具有一定的临床价值。
Objective: To investigate the clinical value of the number and nature of acute ventricular premature ventricular contractions in patients with acute heart failure (HF) for long-term prognosis and risk stratification assessment. Methods: A total of 230 patients with acute heart failure who were enrolled from 2012-03-2015-02 were followed up for 18 months. The clinical indexes and the number and nature of ventricular premature death in both death and non-death groups were analyzed. Long-term prognosis. The end point is defined as all-cause death. Results: The total number of premature ventricular asphyxia (P = 0.005), pleomorphic premature ventricular (P = 0.03) was associated with an 18-month risk of mortality in patients with acute heart failure, whereas 18 patients with non-sustained ventricular tachycardia and acute heart failure No significant correlation between monthly risk of death. Multivariate COX regression model found that the acute premature ventricular total number of patients with acute heart failure (HR1.193, P = 0.04), NT-proBNP, serum sodium and systolic blood pressure were all independent predictors of all-cause mortality. The area under the curve (AUC) of ROC curve showed a total of 0.642, the best predicted value was 1 193 / 24h, the sensitivity was 53.7% and the specificity was 73.6%. Kaplan-Meier survival curves showed a higher incidence of all-cause mortality in patients with frequent pleomorphic ventricular enlargement. Conclusion: The number of acute ventricular premature beats in patients with acute heart failure as a predictor of long-term prognosis and risk stratification has a certain clinical value.