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目的探讨扩张型心肌病(DCM)患者左心室重构对患者生存时间及预后的影响。方法选取南宁市第二人民医院122例DCM患者,所有患者于入院时行常规经胸彩色多普勒超声心动图检查,测量左室射血分数(LVEF)、短轴缩短率(FS)为左室收缩功能指标;取心尖四腔切面测量左室舒张末的长轴径(L)和短轴径(D)计算球形指数(SI=L/D)以及左房收缩末期内径(LADs)、左室舒张末期内径(LVD)为左室重构指标。所有DCM患者随访1~48个月,根据是否发生心源性死亡分为死亡组和生存组,比较两组上述指标。结果死亡组入院时SI、LVEF、FS水平明显低于生存组,而LADs、LVD水平明显高于生存组(均P<0.01);同时SI与LVEF、FS呈显著正相关(r值分别为0.581和0.513),与LADs、LVD呈显著负相关(r值分别为-0.573和-0.509)(均P<0.01);与生存时间相关的指标分别是SI(B=1.378,P<0.05)、LADs(B=0.081,P<0.05)。结论左心室重构可作为反映DCM患者心力衰竭严重程度的指标之一,SI、LADs对DCM患者生存时间及预后有一定的预测价值。
Objective To investigate the effect of left ventricular remodeling on survival time and prognosis in patients with dilated cardiomyopathy (DCM). Methods A total of 122 patients with DCM in Nanning Second People’s Hospital were enrolled in the study. All patients underwent routine transthoracic color Doppler echocardiography at admission to measure left ventricular ejection fraction (LVEF) and short axis shortening (FS) (L = D) and left atrial systolic diameter (LADs) were calculated from the apex four-chamber view of the left ventricular end-diastolic diameter (L) and short axis diameter Ventricular end-diastolic diameter (LVD) is an indicator of left ventricular remodeling. All DCM patients were followed up for 1 ~ 48 months. According to whether there was cardiac death or not, the patients were divided into death group and survival group. The above indexes were compared between the two groups. Results The levels of SI, LVEF and FS in the death group were significantly lower than those in the survival group, while the levels of LADs and LVD in the death group were significantly higher than those in the survival group (all P <0.01). Meanwhile, there was a significant positive correlation between SI and LVEF and FS (r = 0.581 And 0.513 respectively), but negatively correlated with LADs and LVD (r = -0.573 and -0.509 respectively) (all P <0.01). The survival time related indexes were SI (B = 1.378, P <0.05) (B = 0.081, P <0.05). Conclusions Left ventricular remodeling can be used as an index to reflect the severity of heart failure in patients with DCM. SI and LADs have some predictive value for the survival time and prognosis of patients with DCM.