The predictive value of the heart failure echocardiography index and N-terminal pro-brain natriuretic peptide to the prognosis in patients with diastolic heart failure
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摘要: 目的:分析心力衰竭超声指数 (HFEI) 与N末端脑钠肽前体 (NT-proBNP) 水平对预测舒张性心力衰竭 (DHF) 患者预后的临床价值。方法:选择我院就诊的120例DHF患者作为研究对象, 根据随访1年结局不同分为:对照组, 共82例, 未发生主要不良心血管事件 (MACE) ;研究组, 共38例, 发生MACE。选择我院健康体检者50例为健康组。检测并比较左室射血分数 (LVEF) 、左室舒张末期直径 (LVEDd) 、E/A比值、HFEI与血浆NT-proBNP水平的差异。应用多元Logistic回归分析上述指标与患者MACE发生的相关性。应用受试者工作特征曲线 (ROC) 判断HFEI与NT-proBNP水平对DHF患者预后不良的诊断性能。结果:3组LVEF、LVEDd、E/A比值、HFEI与血浆NT-proBNP水平均存在差异 (均P<0.05) ;两组LVEF无显著差异, 但均低于健康组 (均P<0.05) ;研究组LVEDd、HFEI与血浆NT-proBNP水平最高, 对照组次之, 健康组最低 (P<0.05) , 而研究组E/A比值最低, 对照组次之, 健康组最高 (P<0.05) 。多元Logistic回归分析显示, HFEI与血浆NT-proBNP是DHF患者MACE发生的危险因素 (OR=2.652, P=0.025;OR=2.919, P=0.028) 。ROC曲线判定HFEI为7.0及血浆NT-proBNP为550.5pg/ml对预测DHF患者MACE有85.8%的灵敏度和90.2%的特异度 (P=0.016) 。结论:HFEI与血浆NT-proBNP联合检测对预测DHF患者MACE发生有较高价值, 可作为评估DHF患者预后的重要指标。Abstract: Objective:To analyze the predictive value of the heart failure echocardiography index (HFEI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) to the prognosis in patients with diastolic heart failure (DHF) .Method:A total of 120 patients diagnosed to DHF were collected and divided into two groups according to the major adverse cardiac events (MACE) of one-year follow-up.They were control group (82 cases, non-compliance with major adverse cardiac events) and research group (38 cases, compliance with MACE) .The 50 cases of healthy controls in our hospital were collected to healthy group.The indexes of left ventricular ejection function (LVEF) , left ventricular end-diastolic diameter (LVEDd) , the ratio of E/A, HFEI and plasma level of NT-proBNP were detected.The relationship of the above indexes to the occurrence of MACE in patients with DHF was analyzed by multivariate Logistic regression analysis.The clinical value of the HFEI and the plasma levels of NTproBNP to the poor prognosis to patients with DHF were analyzed by the receiver operating characteristic (ROC) curve.Result:The indexes of LVEF, LVEDd, the ratio of E/A, HFEI and plasma level of NT-proBNP were different among three groups (P<0.05) .The indexes of LVEF were no different between control group and research group (P>0.05) , but were both lower than healthy group (P<0.05) .The indexes of LVEDd, HFEI and plasma level of NT-proBNP in research group were highest, and the healthy group were lowest (P<0.05) .The ratio of E/A in research group were lowest, and the healthy group were highest (P<0.05) .The HFEI and the plasma levels of NT-proBNP were the risk factors to the occurrence of MACE in patients with DHF by the multivariate Logistic regression analysis (OR=2.652, P=0.025;OR=2.919, P=0.028) .The ROC curve identified the cutoff levels of the HFEI (7.0) and the plasma levels of NT-proBNP (550.5 pg/ml) that predicted the poor prognosis of patients with DHF with the sensitivity of 85.8% and specificity of 90.2% (P=0.016) .Conclusion:The combination of HFEI and the plasma NT-proBNP can predict the occurrence of MACE in patients with DHF and can be the important indexes of evaluating the prognosis in patients with DHF.
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