CAJ | 학술논문

目的：分析肺动脉高压( PAH )对心脏再同步治疗( CRT )临床获益的预测价值。方法2007年3月至2012年6月在上海复旦大学附属中山医院植入CRT的165例患者回顾性分析,根据术前肺动脉收缩压(SPAP)将其分为SPAP<50 mmHg(1 mmHg=0．133 kPa,n=107)与SPAP≥50 mmHg (n=58)两组。以全因死亡为主要终点事件,心力衰竭再住院为次要终点事件,分析两组生存函数差异,并通过Cox回归模型分析终点事件的预测因子。结果 SPAP≥50 mmHg组与SPAP<50 mmHg组死亡例数分别为13例(22．4%)和8例(7．5%),心力衰竭再住院例数分别为25例(43．1%)和21例(19．6%),两者差异有统计学意义(P<0．01)。 Kaplan-Meier生存分析显示,与SPAP<50 mmHg组比较, SPAP≥50 mmHg者累积生存率较低( P<0．05),累积再住院率则较高( P<0．01)。多因素回归分析显示,SPAP≥50 mmHg者主要终点事件风险比3．089(95%CI 1．117~8．543,P=0．03),次要终点事件风险比2．465(95%CI 1．318~4．611,P=0．005)。结论中-重度PAH患者CRT后临床获益不佳,且是全因死亡和心力衰竭再住院的独立预测因子。
목적：분석폐동맥고압( PAH )대심장재동보치료( CRT )림상획익적예측개치。방법2007년3월지2012년6월재상해복단대학부속중산의원식입CRT적165례환자회고성분석,근거술전폐동맥수축압(SPAP)장기분위SPAP<50 mmHg(1 mmHg=0．133 kPa,n=107)여SPAP≥50 mmHg (n=58)량조。이전인사망위주요종점사건,심력쇠갈재주원위차요종점사건,분석량조생존함수차이,병통과Cox회귀모형분석종점사건적예측인자。결과 SPAP≥50 mmHg조여SPAP<50 mmHg조사망례수분별위13례(22．4%)화8례(7．5%),심력쇠갈재주원례수분별위25례(43．1%)화21례(19．6%),량자차이유통계학의의(P<0．01)。 Kaplan-Meier생존분석현시,여SPAP<50 mmHg조비교, SPAP≥50 mmHg자루적생존솔교저( P<0．05),루적재주원솔칙교고( P<0．01)。다인소회귀분석현시,SPAP≥50 mmHg자주요종점사건풍험비3．089(95%CI 1．117~8．543,P=0．03),차요종점사건풍험비2．465(95%CI 1．318~4．611,P=0．005)。결론중-중도PAH환자CRT후림상획익불가,차시전인사망화심력쇠갈재주원적독립예측인자。
Objective To investigate the usefulness of elevated systolic pulmonary artery pressure ( SPAP ) to predict clinical outcome in patients receiving cardiac resynchronization therapy ( CRT ) . Methods The present study retrospectively analyzed data from 165 subjects undergoing CRT,who were strati-fied into two groups according to echocardiographic assessments of SPAP (107 cases with SPAP<50 mmHg and 58 cases with SPAP≥50 mmHg) . The primary endpoint of all-cause mortality and secondary endpoint of heart failure rehospitalization were compared between the two groups using Kaplan-Meier method. Cox regression mod-els were also run for both end points. Results Thirteen (22. 4%) patients died and 25 (43. 1%) were read-mitted for heart failure in patients with SPAP≥50 mmHg,with a significantly higher incidence than subjects with SPAP<50 mmHg,among whom 8 (7. 5%) patients died and 21(19. 6%) were rehospitalized (P<0. 01 for both) . Compared with SPAP<50 mmHg,those with SPAP≥50 mmHg had significantly shorter survival ( P<0. 05) and higher occurrence of readmission for heart failure (P<0. 01) based on Kaplan-Meier analysis. In a multivariate model,subjects with SPAP≥50 mmHg were significantly more likely to reach both primary end-point (hazard ratio 3. 089,95% confidence interval 1. 117 to 8. 543,P=0. 03) and secondary endpoint (hazard ratio 2. 465,95% confidence interval 1. 318 to 4. 611,P=0. 005). Conclusion In patients receiving CRT,an elevated baseline SPAP is associated with adverse clinical outcome and is an independent predictor of all-cause mortality and heart failure readmission.