| 1 | Clinical characteristics, treatment and prognosis of patients with idiopathic dilated cardiomyopathy: a tertiary center experience显示文摘Background Contemporary heart failure medications have led to considerable improvement in the survival of patients with heart failure. However,limited evidence is available regarding the effect of those medications in patients with idiopathic dilated cardiomyopathy (IDCM),particularly in China. We sought to analyze the trends in clinical characteristics and the prescription rate of recommended therapies and its prognostic impact in patients with IDCM. Methods From 2009 to 2016,1441 consecutive patients (age: 55±14 years,68% men,LVEF: 33%± 12%) fulfilling World Health Organization criteria for IDCM were enrolled in the current retrospective cohort study. Temporal trends of baseline clinical characteristics,treatment and prognosis were analyzed,and potential influential factors were explored. Results Rates of patients receiving angiotensin-converting enzyme inhibitors/angiotensin II receptors blockers,β-blockers,aldosterone receptor antagonists and diuretics increased from 55%,45%,58%,51% in 2009 to 67%,69%,71%,64% in 2016,respectively (P < 0.05);whereas,the proportion of patients receiving digoxin decreased from 39% in 2009 to 28% in 2016 (P < 0.05). The overall proportion of patients with optimal guideline-directed medical therapy (GDMT) was 44.6%;however,that rate increased from 33% in 2009 to 41%,49% and 56% in 2012,2014 and 2016 respectively (P < 0.05). Patients with optimal GDMT had a better outcome than those without,but there was no temporal trend toward improvement in the overall long-term prognosis of IDCM patients with the years. There was a trend towards admission of patients with milder disease and toward increased admission to a cardiology ward with the years. Conclusions An improvement in prescription rates of guideline-recommended medications in IDCM patients was observed. However,it remains suboptimal,and there is still some room for improvement. The prognosis of patients with optimal GDMT was better than those without. Moreover,the following patient category also had an improved prognosis: patients with LVEF ≥ 40%,with device therapy,and those admitted to a cardiology ward. | Abdullah Hagar Xiao-Bo PU Shi-Jian CHEN Jageshwar-Prasad Shah Mao CHEN | 2019 | Journal of Geriatric Cardiology2019，16，4： | 4 |
| 2 | 急性心肌梗死合并左室射血分数降低患者远期死亡的预测模型显示文摘目的探讨影响急性心肌梗死合并左室射血分数降低患者远期死亡的危险因素,建立预测模型并进行验证。方法这项回顾性队列研究共纳入1013例于2010年12月-2019年6月在四川大学华西医院住院并诊断为急性心肌梗死合并左室射血分数降低的患者,使用Excel软件的RAND函数将研究人群随机分为3组,其中2组合并为模型建立队列,1组为模型验证队列。终点事件为全因死亡,随访工作截至2021年1月20日。使用Cox比例风险模型筛选影响患者远期死亡的危险因素,建立基于这些因素的预测模型并进行验证。结果中位随访时间为1377 d,共296例患者死亡。多因素Cox回归分析示年龄≥65岁[风险比(hazard ratio,HR)=1.842,95%置信区间(confidence interval,CI)(1.067,3.179),P=0.028]、Killip分级≥Ⅲ级[HR=1.941,95%CI(1.188,3.170),P=0.008]、氨基末端脑钠肽前体≥5598 pg/mL[HR=2.122,95%CI(1.228,3.665),P=0.007]、未行经皮冠状动脉介入治疗[HR=2.181,95%CI(1.351,3.524),P=0.001]、未使用他汀类药物[HR=2.441,95%CI(1.338,4.454),P=0.004]、未使用β受体阻滞剂[HR=1.671,95%CI(1.026,2.720),P=0.039]是远期死亡的独立危险因素。建立预测模型,根据总分分为低危组(0~2分)、中危组(4~6分)、高危组(8~12分)3个风险组。受试者工作特征曲线[曲线下面积=0.724,95%CI(0.680,0.767),P<0.001]和Hosmer-Lemeshow检验(P=0.108)、Kaplan-Meier生存曲线(P<0.001)结果表明该预测模型有良好的预测能力和拟合度,对不同组别也有良好的区分度。并于模型验证队列中得到验证[曲线下面积=0.758,95%CI(0.703,0.813),P<0.001]。结论年龄≥65岁、Killip分级≥Ⅲ级、氨基末端脑钠肽前体≥5598 pg/mL、未行经皮冠状动脉介入治疗、未使用他汀类药物、未使用β受体阻滞剂是急性心肌梗死合并左室射血分数降低的患者远期死亡的独立危险因素,基于此建立的预测模型有良好的预测能力。 | 杨博森 黄宝涛 陈飞 白琳 程乙恒 张逸柯 Abdullah Hagar 黄方洋 肖乾凤 蒲小波 彭勇 陈茂 | 2022 | 华西医学2022，37，3： | 1 |
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