【摘要】 目的 探讨左心房存储应变对老年心力衰竭(心衰)病人远期不良预后的预测价值。方法 前瞻性选取2018年7月至2019年7月承德市中心医院收治的136例年龄≥65岁老年心衰病人为研究对象，随访观察2年，以全因死亡作为不良预后，并以此分为预后不良组和预后良好组，采用多因素Cox回归分析老年心衰病人远期不良预后的影响因素。结果 截至随访终点，失访11例，最终125例获得随访，其中42例(33.60%)出现全因死亡(预后不良);83例(66.40%)预后良好。预后不良组与预后良好组左心房容积指数(LAVI)、左心房储备期应变(LARS)、LVEF及N末端B型利钠肽原(NT-proBNP)水平比较，差异具有统计学意义(P<0.01)。多因素Cox回归分析显示，NT-proBNP(HR=1.001,95%CI:1.000～1.002)、LAVI(HR=1.082,95%CI:1.002～1.168)为老年心衰病人远期不良预后的独立危险因素，LVEF(HR=0.944,95%CI:0.893～0.998)、LARS(HR=0.945,95%CI:0.902～0.991)为老年心衰病人远期不良预后的保护因素。ROC曲线分析显示，LARS(AUC=0.847,95%CI:0.772～0.905)对远期不良预后的预测价值高于LVEF(AUC=0.670,95%CI:0.650～0.811)和LAVI(AUC=0.698,95%CI:0.721～0.868)。结论 LAVI、LARS、LVEF及NT-proBNP可预测老年心衰病人远期不良预后，LARS是优于LAVI、LVEF的左心房参数。更多还原

【Abstract】 Objective To explore the predictive value of left atrial strain for the long-term poor prognosis of elderly patients with heart failure. Methods A total of 136 elderly patients with heart failure age ≥ 65 years old admitted to Chengde Central Hospital from July 2018 to July 2019 were prospectively selected as the research subjects. The patients were followed up for 2 years. According to the all-cause death results, they were divided into poor prognosis group and good prognosis group. The influencing factors of long-term poor prognosis of the elderly patients with heart failure were analyzed by multivariate Cox regression. Results By the end of the follow-up, 42 cases(33.60%) presented with all-cause death and 83 cases(66.40%) with a good prognosis. There were significant differences in the levels of left atrial volume index(LAVI), left atrial reserve strain(LARS), left ventricular ejection fraction(LVEF) and N-terminal pro-B-type natriuretic peptide(NT-proBNP) between poor prognosis group and good prognosis group. Multivariate Cox regression analysis showed that NT-proBNP(HR=1.001, 95%CI: 1.000-1.002) and LAVI(HR=1.082, 95%CI:1.002-1.168) were the independent risk factors of long-term poor prognosis, and LVEF(HR=0.944, 95%CI:0.893-0.998) and LARS(HR=0.945, 95%CI:0.902-0.991) were the protective factors of long-term poor prognosis in the elderly patients with heart failure(all P<0.05). ROC curve analysis showed that the area under curve(AUC) of LARS was higher than that of LVEF and LAVI. Conclusions LAVI, LARS, LVEF and NT-proBNP can predict the long-term poor prognosis of elderly patients with heart failure, and LARS is more valuable than other parameters.更多还原