摘要
目的 本研究分析住院扩张型心肌病(DCM)患者长期随访中超声心动图指标恢复及复发情况.方法 入选2009年1月至2013年12月在阜外医院心力衰竭监护病房住院且复查超声心动图的DCM患者,随访至2015年12月或发生全因死亡或心脏移植.定义随访时左心室射血分数(LVEF)≥50%(较基线提高≥10%)且左心室舒张末期内径(LVEDD)≤55 mm(较基线缩小≥5 mm)为超声心动图指标恢复.定义恢复患者LVEF≤40%或LVEDD≥60 mm为超声心动图指标复发.结果 有465例DCM患者纳入本研究,超声心动图中位随访33(15,49)个月后有134例超声心动图指标恢复(恢复率28.8%),其LVEF由基线时(30.8±6.0)%明显提高至首次恢复时(55.7±4.3)%,LVEDD由(64.5 ±5.6)mm缩小至(51.0 ±3.1)mm(P均<0.01),中位恢复时间为12(6,21)个月.入院时心力衰竭症状病史、LVEDD、右心室前后径、血钠浓度及出院时收缩压水平是恢复的独立预测因素(P均<0.01).134例恢复患者中有103例恢复后复查超声心动图,中位随访26(16.43)个月,其中16例超声心动图指标复发(复发率15.5%),其LVEF从首次恢复时(56.9±3.8)%明显降低至首次复发时(36.7±5.7)%,LVEDD从(52.3±2.4) mm增大至(64.6 ±6.1)mm(P均<0.01),中位复发时间为25(8,32)个月,未发现复发的独立预测因素.临床中位随访42(17,58)个月,恢复患者的无心脏移植存活率明显高于未恢复患者(P<0.01).结论 住院DCM患者出院后随访3年时约30%患者超声心动图指标恢复,其长期预后优于未恢复患者.恢复患者恢复后继续随访2年时约16%患者超声心动图指标复发,未发现复发的独立预测因素.
Objective To investigate the echocardiographic recovery and relapse at long-term follow-up in hospitalized patients with dilated cardiomyopathy(DCM).Methods Patients with DCM hospitalized in Heart Failure Care Unit,Fuwai Hospital between 2009-01 and 2013-12 who had repeat echocardiography(ECHO)after discharge were followed to 2015-12 or until all-cause death or cardiac transplantation.Recovery was defined as an absolute increase in left ventricular ejection fraction(LVEF)≥10%to a level of≥50%and decrease in left ventricular end-diastolic diameter(LVEDD)≥5 mm to a level of≤55 mm on follow-up and relapse was defined as LVEF≤40%or LVEDD≥60 mm after initial recovery.Results A total of 465 patients with DCM were enrolled in this analysis.After a median follow-up of 33(15,49)months with repeat ECHO,134 patients(28.8%)achieved recovery,showing a significant increase in LVEF from(30.8±6.0)%at baseline to(55.7±4.3)%at initial recovery and decrease in LVEDD from(64.5±5.6)mm to(5 1.0±3.1)mm(both P<0.01),with median recovery duration of 12(6,21)months.Symptom duration of heart failure,LVEDD,right ventricular diameter,serum sodium on admission and systolic blood pressure on discharge were found to be independent predictors of recovery(all P<0.01).Among 134 recovered patient,103 had repeat ECHO after initial recovery,with a median furthe follow up duration of 26(16.43)months,of whom 16(15.5%)suffered relapse,showing a significant decrease in LVEF from(56.9±3.8)%at initial recovery to(36.7±5.7)%at initial relapse and increase in LVEDD from(52.3±2.4)mm to(64.6±6.1)mm(both P<0.01),with a median relapse duration of 25(8,32)months.There was no independent predictor of relapse.Recovered patients had a significant higher transplant-free survival rate than those without recovery at a clinical follow-up duration of 42(17,58)months(P<0.01).Conclusion About 30%hospitalized patients with DCM can achieve recovery at 3-year follow-up after discharge,which was associated with better long-term prognosis.Moreover,around 16%patients with recovery may suffer a relapse after initial recovery though no predictor was found.
作者
邹长虹
黄燕
周琼
张荣成
安涛
吕蓉
张宇辉
张健
Zou Changhong;Huang Yan;Zhou Qiong;Zhang Rongcheng;An Tao;Lyu Rong;Zhang Yuhui;Zhang Jian(Heart Failure Center,Fuwai Hospital,National Center far Cardiovascular Diseases,Chinese Academy of Medical Sciences,167 Beilishi Road,Beijing 100037,China)
基金
“十二·五”国家科技支撑计划项目(2011BAI11B02).
关键词
心肌病
扩张型
预后
Cardiomyopathy,dilated
Prognosis
