CAJ | 학술논문

目的探讨心房颤动(房颤)对慢性收缩性心力衰竭(chronic systolic heart failure,CSHF)住院患者远期预后的影响.方法回顾性调查和分析湖北地区8地市12家三级甲等医院2000年至2010年CSHF住院患者资料,单因素Kaplan-Meier曲线分析房颤和非房颤组总死亡、心血管病死亡、心脏泵功能衰竭死亡(心力衰竭死亡)、心脏性猝死和栓塞相关死亡差异.多因素Cox生存分析确认心力衰竭患者不同预后的危险因素.结果 ①共16681例患者纳入本次研究.房颤组与非房颤组相比,年龄(64.54 ±13.61)岁比(62.19±15.07)岁(P＜0.01)、左心室射血分数(LVEF)37.43± 12.72比38.42±13.96(P＜0.01)、心功能Ⅲ～Ⅳ级(NYHA分级)患者(5547/81.49％比7121/72.12％,P＜0.01)和病因等因素存在差异.②单因素Kaplan-Meier曲线分析发现,房颤组和非房颤组在总死亡、心血管病死亡、心力衰竭死亡和栓塞相关死亡存在差异,而在心律失常相关的心脏性猝死两组间差异无统计学意义.③多因素Cox回归分析发现房颤不是总死亡、心血管病死亡、心力衰竭死亡和心脏性猝死增加的独立危险因素,而增加栓塞相关死亡(HR=2.134,95％ CI,1.846～2.430,P＜0.0l)结论房颤不增加CSHF患者远期总死亡、心血管病死亡、心力衰竭死亡和心脏性猝死,而增加栓塞相关死亡.提示房颤引起CSHF患者远期预后不良的原因可能在于其并发症.
목적 탐토심방전동(방전)대만성수축성심력쇠갈(chronic systolic heart failure,CSHF)주원환자원기예후적영향.방법 회고성조사화분석호북지구8지시12가삼급갑등의원2000년지2010년CSHF주원환자자료,단인소Kaplan-Meier곡선분석방전화비방전조총사망、심혈관병사망、심장빙공능쇠갈사망(심력쇠갈사망)、심장성졸사화전새상관사망차이.다인소Cox생존분석학인심력쇠갈환자불동예후적위험인소.결과 ①공16681례환자납입본차연구.방전조여비방전조상비,년령(64.54 ±13.61)세비(62.19±15.07)세(P＜0.01)、좌심실사혈분수(LVEF)37.43± 12.72비38.42±13.96(P＜0.01)、심공능Ⅲ～Ⅳ급(NYHA분급)환자(5547/81.49％비7121/72.12％,P＜0.01)화병인등인소존재차이.②단인소Kaplan-Meier곡선분석발현,방전조화비방전조재총사망、심혈관병사망、심력쇠갈사망화전새상관사망존재차이,이재심률실상상관적심장성졸사량조간차이무통계학의의.③다인소Cox회귀분석발현방전불시총사망、심혈관병사망、심력쇠갈사망화심장성졸사증가적독립위험인소,이증가전새상관사망(HR=2.134,95％ CI,1.846～2.430,P＜0.0l)결론 방전불증가CSHF환자원기총사망、심혈관병사망、심력쇠갈사망화심장성졸사,이증가전새상관사망.제시방전인기CSHF환자원기예후불량적원인가능재우기병발증.
Objective To investigate the prognostic value of atrial fibrillation (AF) in patients with chronic systolic heart failure (CSHF).Methods Data of in-hospital patients with CSHF were investigated between 2000 and 2010 from 12 hospitals in Hubei Province.Inclusion criteria:over 18 years of age,organic heart disease and with the symptom of heart failure (HF) including dyspnea and fatigue.We excluded patients with a history of myocardial infarction in the prior 12 months,congenital heart disease,pericardial disease and the history of cancer.We used x2 tests and t tests for descriptive analyses.Univariate Kaplan-Meier curve was performed to evaluate the difference in prognosis between AF and non-AF group.Multivariate Cox regression analysis was performed to determinate the independent risk factors of all-cause mortality,cardiovascular mortality,HF mortality,sudden cardiac death (SCD) and thrombosis-related mortality,respectively.Statistical tests were evaluated with the use of 2-tailed 95％ confidence levels,and tests with P＜0.01 were considered significant.Data analyses were performed with the use of SPSS 13.0 for Windows,release 15,2006 (.SPSS Inc,Chicago,Ⅲ).Results ①16681 patients were enrolled in the present study of which AF accounted for 40.81％(6807 patients).②During(5.82 ± 1.63 )years follow-up,6453 patients died.The result of univariate KaplanMeier curve showeds there was significant difference in all-cause mortality,cardiovascular mortality,HF mortality and thrombosis-related mortality while not in SCD.③The result of multivariate Cox regression analysis showed AF was not the independent risk factor of all-cause mortality,cardiovascular mortality,HF mortality or SCD.AF increased thrombosis-related mortality ( HR =2.134,95％ CI, 1.846 ～ 2.430,P ＜ 0.01 ).Conclusions AF increased thrombosis-related mortality while not other end-points in patients with CSHF which indicated AF correlated with adverse prognosis lies in its side-effect while not the arrhythmia.