急性心力衰竭患者出入院心率变化与预后相关性

doi:10.6040/j.issn.1671-7554.0.2024.0949

摘要/Abstract

摘要： 目的探讨急性心力衰竭患者出入院心率变化与预后的相关性。方法选取山东大学齐鲁医院2018年1月至2021年11月间被诊断为急性心力衰竭的169例患者,并对其进行为期1年的出院后随访。以出入院心率差值的中位值11次/min为切点,将患者分为出入院心率差值<11次/min(n=84)与出入院心率差值≥11次/min(n=85)两组。比较两组患者的社会人口学资料、体格检查、基础疾病史、实验室检查等基线信息特征。Log-rank检验比较两组患者随访1年生存率的差异,并绘制Kaplan-Meier生存曲线。对于主要结局终点,多因素Cox回归探索患者出入院心率变化与易损期及随访1年的生存状况的关系。对于次要结局终点,多因素Cox回归分析患者出入院心率变化与易损期再发病、1年再发病的关系;二分类Logistic分析患者出入院心率变化与6分钟步行距离的关系;多元线性回归探索患者出入院心率变化与生活质量的关系。结果 Log-rank分析表明,出入院心率差值<11次/min组患者死亡风险高于出入院心率差值≥11次/min组患者,两组间1年全因死亡率差异有统计学意义(Log-rank P=0.002)。多因素Cox回归分析表明,出入院心率差值<11次/min组患者的死亡风险(易损期:HR=2.939, 95%CI:1.038~8.321;随访1年:HR=3.837, 95%CI:1.383~10.644)高于出入院心率差值≥11次/min组患者,且差异有统计学意义(P<0.05)。年龄偏大(HR=1.046, 95%CI:1.008~1.085, P=0.017)、有房颤病史(HR=2.530, 95%CI:1.019~6.278, P=0.045)、出入院心率差值<11次/min(HR=3.837, 95%CI:1.383~10.644, P=0.010)及NT-proBNP下降低于30%(HR=4.269, 95%CI:1.809~10.074, P=0.001)是急性心力衰竭患者全因死亡的独立危险因素。Cox回归分析表明,出入院心率差值<11次/min组患者的发病风险(随访1年:HR=1.794, 95%CI:1.150~2.799)高于出入院心率差值≥11次/min组患者,两组间的1年再发病率差异有统计学意义(P<0.05)。二分类Logistic回归结果表明,出入院心率差值<11次/min组患者6分钟步行距离<450 m的发病风险(OR=4.593, 95%CI: 2.184~9.661)远高于出入院心率差值≥11次/min组的患者,且差异有统计学意义(P<0.05)。结论急性心力衰竭患者出入院心率变化与患者1年内死亡有关。出入院心率差值越小,患者出院随访1年内的死亡风险越高。在1年再发病以及6分钟步行距离等方面,出入院心率差较大患者的获益显著高于心率差较小患者。

关键词: 急性心力衰竭, 心率, 再入院, 死亡率, 危险因素

Abstract: Objective To explore the correlation between heart rate changes at admission and discharge and prognosis in patients with acute heart failure. Methods One hundred and sixty-nine patients diagnosed with acute heart failure at Qilu Hospital of Shandong University were included from January 2018 to November 2021, then a one-year follow-up was conducted. Using the median value of 11 beats/min as the cutoff for the difference in heart rate at admission and discharge, patients were divided into the heart rate difference <11 beats/min group(n=84)and the heart rate difference ≥11 beats/min group(n=85). The baseline demographic characteristics, physical examination, history of underlying diseases, and laboratory test results between the two groups were compared. Log-rank test was used to compare the difference in one-year survival rates between the two groups, and Kaplan-Meier survival curves were plotted. For the primary outcome, multivariate Cox regression analysis was conducted to explore the relationship between changes in heart rate at admission and discharge and survival status during the vulnerable period as well as at one-year follow-up. For the secondary outcomes, multivariate Cox regression analysis was conducted to investigate the relationship between changes in heart rate at admission and discharge and the recurrence during the vulnerable period and one year follow-up. Binary Logistic regression analyzed the relationship between changes in heart rate at admission and discharge and the 6-minute walk distance. Additionally, multiple linear regression explored the relationship between patients heart rate changes at admission and discharge and quality of life among patients. Results The results of Log-rank analysis indicated that the patients in the heart rate difference <11 beats/min group had higher risk of death compared to the patients in the heart rate difference ≥11 beats/min group, with a statistically significant difference in one-year all-cause mortality(Log-rank P=0.002). Multivariate Cox regression indicated that the patients in the heart rate difference <11 beats/min group had higher risk of death(vulnerable period: HR=2.939, 95%CI: 1.038-8.321; one-year follow-up: HR=3.837, 95%CI: 1.383-10.644), with statistically significant differences(P<0.05). Older age(HR=1.046, 95%CI: 1.008-1.085, P=0.017), history of atrial fibrillation(HR=2.530, 95%CI: 1.019-6.278, P=0.045), heart rate difference <11 beats/min(HR=3.837, 95%CI:1.383-10.644, P=0.010), and NT-proBNP reduction <30%(HR=4.269, 95%CI: 1.809-10.074, P=0.001)were independent risk factors for all-cause mortality in acute heart failure patients. Cox regression analysis showed that the patients in the heart rate difference <11 beats/min group had higher risks of disease(one-year follow-up: HR=1.794, 95%CI: 1.150-2.799)compared to the patients in the heart rate difference ≥11 beats/min group, with a statistically significant difference in one-year rehospitalization rate(P<0.05). The results of binary Logistic regression indicated that patients in the heart rate difference <11 beats/min group had significantly higher risk(OR=4.593, 95%CI: 2.184-9.661)of a 6-minute walking distance less than 450 meters compared to the patients in the heart rate ≥ 11 beats/min group(P<0.05). Conclusion Changes of heart rate between admission and discharge in patients with acute heart failure are associated with mortality within one year. A smaller heart rate difference is associated with a higher risk of death within one year after discharge. Patients with a greater heart rate differential at admission and discharge have a significantly greater benefit than patients with a smaller heart rate differential in terms of 1-year rehospitalization and 6-minute walk distance.

Key words: Acute heart failure, Heart rate, Rehospitalization, Mortality, Risk factors

中图分类号:

R541.6

李敬,郝盼盼. 急性心力衰竭患者出入院心率变化与预后相关性[J]. 山东大学学报 (医学版), 2025, 63(4): 75-82.

LI Jing, HAO Panpan. Association between the heart rate variation and the prognosis in patients with acute heart failure at hospital admission and discharge[J]. Journal of Shandong University (Health Sciences), 2025, 63(4): 75-82.

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