【摘要】 目的:探究冠状动脉(冠脉)慢性完全闭塞病变经皮介入治疗(CTO-PCI)术后射血分数改善型心力衰竭(心衰)的影响因素及其长期预后。方法:回顾性入选CTO-PCI术前左室射血分数(LVEF)≤40%的心衰患者229例，根据术后1年LVEF的变化分为射血分数改善型心衰(HFimpEF)组(71例)和非射血分数改善型心衰(non-HFimpEF)组(158例)。采用logistic回归筛选CTO-PCI术后HFimpEF的影响因素；使用Cox回归探究主要不良心血管事件(MACE)的影响因素，并通过Kaplan-Meier生存分析比较两组的预后差异，同时基于倾向性评分匹配(PSM)进行敏感性分析。结果:Logistic回归结果示，年龄<60岁、左室舒张末期内径(LVEDD)<60 mm、J-CTO评分<3以及应用β受体阻滞剂和钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)与CTO-PCI术后射血分数改善相关(P<0.05)。PSM前后的Cox回归结果均表明，HFimpEF是患者CTO-PCI术后发生MACE的独立保护因素(P<0.01)。PSM前后的Kaplan-Meier曲线显示HFimpEF组的无MACE生存率高于non-HFimpEF组(P<0.01)。结论:年龄<60岁、LVEDD<60 mm、J-CTO评分<3以及应用β受体阻滞剂和SGLT2i是CTO-PCI术后HFimpEF的独立影响因素，HFimpEF患者拥有更好的长期预后。更多还原

【Abstract】 Objective: To investigate the predictors and long-term prognosis of heart failure with improved ejection fraction(HFimpEF) after chronic total occlusion percutaneous coronary intervention(CTO-PCI). Methods: A total of 229 heart failure patients with left ventricular ejection fraction(LVEF) ≤40% before CTO-PCI were retrospectively enrolled and divided into HFimpEF group(n=71) and non-HFimpEF group(n=158) according to the change in LVEF at 1 year after CTO-PCI. Binary logistic regression was used to screen the predictors of HFimpEF after CTO-PCI. Cox regression was used to explore the factors influencing major adverse cardiovascular events(MACE). Kaplan-Meier survival analysis was used to compare the prognostic differences between two groups, and sensitivity analysis was performed based on propensity score matching(PSM). Results: Logistic regression analysis showed that age<60 years, left ventricular end-diastolic diameter(LVEDD)<60 mm, J-CTO score<3, and the use of β-blockers and sodium-glucose cotransporter 2 inhibitors(SGLT2i) were associated with improved ejection fraction after CTO-PCI(P<0.05). Cox regression analysis before and after PSM showed that HFimpEF was an independent protective factor for MACE after CTO-PCI(P<0.01). Kaplan-Meier survival analysis showed higher MACE-free survival in the HFimpEF group than in the non-HFimpEF group(P<0.01). Conclusion: Age<60 years, LVEDD<60 mm, J-CTO score<3, and the use of β-blockers and SGLT2i were predictors of HFimpEF after CTO-PCI, and this patient population had a better long-term prognosis.更多还原