肺动脉高压对心脏再同步治疗术后生存的预测价值

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。

Value of pulmonary arterial hypertension in predicting survival after cardiac resynchronization therapy

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.