心脏瓣膜钙化对老年冠心病病人预后的影响

doi:10.3969/j.issn.1003-9198.2024.03.008

摘要/Abstract

摘要： 目的探讨老年冠心病病人心脏瓣膜钙化(CVC)与主要不良心脑血管事件(MACCE)的相关性。方法入选140例老年冠心病病人,采用心脏彩超评估病人心脏瓣膜情况,分为 CVC 组和无 CVC 组,分析2组临床资料、颈动脉超声及心脏超声数据。对病例进行随访,记录MACCE发生情况,通过Kaplan-Meier法分析2组病人MACCE和全因死亡的差异;使用Cox比例风险模型分析MACCE的影响因素。结果 2组年龄、TC、LDL-C、白蛋白、肾小球滤过率(eGFR)差异均有统计学意义(P<0.05或P<0. 01)。随访5年,CVC 组MACCE发生率、全因死亡率均高于无 CVC 组(P<0. 001,P=0. 002)。Cox 回归分析发现,CVC(HR=2.350)、尿素氮(HR=1.104)、左房内径(HR=1.057) 增加病人MACCE的发生风险,但CVC并不增加病人全因死亡的风险。结论高龄、肾功能差的老年冠心病病人更易发生CVC。CVC是老年冠心病病人发生MACCE的独立危险因素,老年冠心病病人合并CVC时预后更差。

关键词: 老年人, 冠心病, 心脏瓣膜钙化, 主要不良心脑血管事件

Abstract: Objective To investigate the correlation between cardiac valve calcification(CVC) and major adverse cardiac and cerebral events(MACCE) in the elderly patients with coronary heart disease(CHD). Methods A total of 140 elderly patients with CHD were enrolled. The patients were divided into CVC group and non-CVC group according to echocardiography. The patients were followed up, and the incidence rate of MACCE and all-cause death were recorded and compared between the two groups by Kaplan-Meier method, and the influencing factors of MACCE were analyzed by Multivariate Cox proportional hazards models. Results There were significant differences in age, total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), albumin, and estimated glomerular filtration rate(eGFR) between the two groups(P<0.05 or P<0. 01). After 5 years of follow-up, the incidence rate of MACCE and all-cause mortality in the CVC group were higher than those in the non-CVC group(P<0.001, P=0.002). Cox regression analysis showed that CVC, urea nitrogen and left atrial diameter increased the risk of MACCE, but CVC did not increase the risk of all-cause death. Conclusions Old age and poor renal function are more prone to presenting with CVC in the elderly patients with CHD. CVC is an independent risk factor for MACCE, and the prognosis is worse in the patients with CVC.

Key words: aged, coronary heart disease, cardiac valve calcification, major adverse cardiac and cerebral event

中图分类号:

R 541.4

查志敏, 刘欢, 王向明, 李秋爽, 郭妍. 心脏瓣膜钙化对老年冠心病病人预后的影响[J]. 实用老年医学, 2024, 38(3): 245-250.

ZHA Zhimin, LIU Huan, WANG Xiangming, LI Qiushuang, GUO Yan. Effect of cardiac valve calcification on prognosis of elderly patients with coronary heart disease[J]. Practical Geriatrics, 2024, 38(3): 245-250.

参考文献

[1] LINDROOS M, KUPARI M, HEIKKILÄ J, et al. Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample [J]. J Am Coll Cardiol, 1993, 21(5): 1220-1225.
[2] KANJANAUTHAI S, NASIR K,KATZ R, et al. Relationships of mitral annular calcification to cardiovascular risk factors: the Multi-Ethnic Study of Atherosclerosis(MESA) [J]. Atherosclerosis, 2010, 213(2): 558-562.
[3] OTTO C M, LIND B K,KITZMAN D W, et al. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly [J]. N Engl J Med, 1999, 341(3): 142-147.
[4] JOHNSON R C, LEOPOLD J A, LOSCALZO J. Vascular calcification: pathobiological mechanisms and clinical implications [J]. Circ Res, 2006, 99(10): 1044-1059.
[5] RAO C, ZHANG H, GAO H, et al. The chinese cardiac surgery registry: design and data audit [J]. Ann Thorac Surg, 2016, 101(4): 1514-1520.
[6] CHEN N X, MOE S M. Vascular calcification: pathophysiology and risk factors [J]. Curr Hypertens Rep, 2012, 14(3): 228-237.
[7] LAZAROS G, TOUTOUZAS K, DRAKOPOULOU M, et al. Aortic sclerosis and mitral annulus calcification: a window to vascular atherosclerosis? [J]. Expert Rev Cardiovasc Ther, 2013, 11(7): 863-877.
[8] LI C, XU S, GOTLIEB A I. The progression of calcific aortic valve disease through injury, cell dysfunction, and disruptive biologic and physical force feedback loops [J]. Cardiovasc Pathol, 2013, 22(1): 1-8.
[9] VÖLZKE H, HARING R, LORBEER R, et al. Heart valve sclerosis predicts all-cause and cardiovascular mortality [J]. Atherosclerosis, 2010, 209(2): 606-610.
[10] NICHOLLS S J, PURI R, ANDERSON T, et al. Effect of evolocumab on coronary plaque composition [J]. J Am Coll Cardiol, 2018, 72(17): 2012-2021.
[11] ROSSEBØ A B, PEDERSEN T R, BOMAN K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis [J]. N Engl J Med, 2008, 359(13): 1343-1356.
[12] CHAN K L, TEO K, DUMESNIL J G, et al. Effect of lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin(ASTRONOMER) trial [J]. Circulation, 2010, 121(2): 306-314.
[13] ROSSI A, BARBIERI A, BENFARI G, et al. Heart valve calcification and cardiac hemodynamics [J]. Echocardiography, 2021, 38(4): 525-530.
[14] LIN F J, ZHANG X, HUANG L S, et al. De novo cardiac valve calcification after hemodialysis in end-stage renal disease patients predicts future cardiovascular events: a longitudinal cohort study [J]. Cardiorenal Med, 2019, 9(4): 229-239.
[15] LU M L, GUPTA S, ROMERO-CORRAL A, et al. Cardiac calcifications on echocardiography are associated with mortality and stroke [J]. J Am Soc Echocardiogr, 2016, 29(12): 1171-1178.
[16] SARAN N, GREASON K L, SCHAFF H V, et al. Does mitral valve calcium in patients undergoing mitral valve replacement portend worse survival? [J]. Ann Thorac Surg, 2019, 107(2): 444-452.
[17] VAN HEMELRIJCK M, TARAMASSO M, GÜLMEZ G, et al. Mitral annular calcification: challenges and future perspectives [J]. Indian J Thorac Cardiovasc Surg, 2020, 36(4): 397-403.