目的 探讨肺动脉搏动指数（pulmonary artery pulsatility index，PAPi）联合心肌微循环指标检测在老年慢性射血分数降低心力衰竭（heart failure with reduced ejection fraction，HFrEF）患者中的临床应用价值。 方法 选取2024年1月至2025年1月在黔南布依族苗族自治州人民医院诊治的老年HFrEF患者108例，平均年龄（72.37 ± 6.54）岁。随访6个月，记录主要不良心血管事件（major adverse cardiovascular events，MACE）发生情况。比较MACE组与非MACE组的临床特征及血流动力学、心肌微循环指标差异。采用多因素logistic回归分析MACE的独立危险因素，并绘制受试者工作特征（receiver operating characteristic，ROC）曲线评价预测价值。 结果 6个月随访中32例（29.63%）发生MACE。MACE组年龄、心房颤动发生率显著高于非MACE组（P < 0.05）。MACE组PAPi低于非MACE组，心肌缺血总负荷及CSI评分高于非MACE组（P < 0.05）。logistic回归显示，PAPi、心肌缺血总负荷及CSI评分是MACE的独立预测因子（P < 0.05）。ROC曲线分析显示，三者联合检测预测MACE的ROC曲线下面积（area under the curve，AUC）为0.948（95%CI：0.888 ~ 0.982），显著高于PAPi（AUC = 0.863，95%CI：0.784 ~ 0.922）、心肌缺血总负荷（AUC = 0.914，95%CI：0.844 ~ 0.959）、CSI评分（AUC = 0.760，95%CI：0.668 ~ 0.837）单独检测（P均< 0.05）。联合检测的敏感度为84.37%，特异度为96.05%。 结论 PAPi、心肌缺血总负荷及CSI评分是老年HFrEF患者发生MACE的重要危险因素，联合检测对预测预后具有较高临床价值。

Objective To investigate the prognostic value of combined assessment of the pulmonary artery pulsatility index （PAPi） and the myocardial microcirculation index in elderly patients with chronic heart failure with reduced ejection fraction （HFrEF）. Methods From January 2024 to January 2025， 108 elderly HFrEF patients were enrolled， with the mean age of （72.37 ± 6.54） years. Patients underwent a 6-month follow-up period， and the occurrence of major adverse cardiovascular events （MACE） was recorded. Clinical characteristics， hemodynamic parameters and myocardial microcirculation index were compared between MACE and non-MACE groups. Independent risk factors for MACE were identified using multivariate logistic regression， and receiver operating characteristic （ROC） curve was employed to assess predictive performance. Results During follow-up， 32 patients （29.63%） experienced MACE. Compared with the non-MACE group， the MACE group exhibited significantly higher age and atrial fibrillation incidence （P < 0.05）. The MACE group had lower PAPi but higher total myocardial ischemia burden and CSI scores than the non-MACE group （P < 0.05）. Multivariate logistic regression identified PAPi， total myocardial ischemia burden， and CSI score as independent predictors of MACE （P < 0.05）. ROC analysis showed that the combination of these 3 indicators achieved an area under the curve （AUC） of 0.948（95%CI： 0.888 - 0.982）， significantly higher than that of PAPi （AUC = 0.863， 95%CI： 0.784 - 0.922）， total myocardial ischemia burden （AUC = 0.914， 95%CI： 0.844 - 0.959）， CSI score （AUC = 0.760， 95%CI： 0.668 - 0.837） when used alone （all P < 0.05）. The combined test demonstrated a sensitivity of 84.37% and specificity of 96.05%. Conclusions PAPi， total myocardial ischemia burden and CSI score represent risk factors for MACE in elderly HFrEF patients. Their combined assessment provides high clinical value for predicting prognosis in this population.