肺动脉搏动指数联合心肌微循环指标对老年慢性射血分数降低心力衰竭患者主要不良心血管事件的预测价值

doi:10.3969/j.issn.1006-5725.2026.08.005

Abstract

Abstract:

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.

Key words: pulmonary artery pulsatility index, myocardial microcirculation, heart failure, elderly, major adverse cardiovascular events

CLC Number:

R592

Guoqiu WANG,Liyong GE,Anning ZENG,Qinyu YANG,Wei LI. Predictive value of combined pulmonary artery pulsatility index and myocardial microcirculation indicators for major adverse cardiovascular events in elderly patients with chronic heart failure with reduced ejection fraction[J]. The Journal of Practical Medicine, 2026, 42(8): 1341-1346.

Figures/Tables 4

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Tab.2

Tab.3

Fig.1

References 25

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指标	MACE组（n = 32）	非MACE组（n = 76）	t/χ²值	P值
年龄/岁	75.65 ± 7.14	71.29 ± 5.83	3.315	0.001
性别/[例（%）]			0.072	0.788
男	19（59.37）	43（56.58）
女	13（40.63）	33（43.42）
BMI/（kg/m²）	24.02 ± 2.95	23.97 ± 2.64	0.087	0.931
吸烟史/[例（%）]	21（65.63）	46（60.53）	0.249	0.618
饮酒史/[例（%）]	20（62.50）	48（63.16）	0.004	0.948
高血压/[例（%）]	22（68.75）	48（63.16）	0.309	0.578
糖尿病/[例（%）]	14（43.75）	29（38.15）	0.294	0.588
冠心病/[例（%）]	18（56.25）	35（46.05）	0.937	0.333
心房颤动/[例（%）]	15（46.88）	16（21.05）	7.337	0.007
NYHA分级/[例（%）]			0.097	0.956
Ⅱ级	4（12.50）	11（14.47）
Ⅲ级	19（59.37）	45（59.21）
Ⅳ级	9（28.13）	20（26.32）
心率/（次/min）	82.24 ± 15.09	80.15 ± 12.49	0.746	0.458
TC/（mmol/L）	4.68 ± 1.12	4.53 ± 0.95	0.710	0.479
TG/（mmol/L）	1.99 ± 0.41	1.95 ± 0.35	0.515	0.608
HDL-C/（mmol/L）	1.11 ± 0.31	1.12 ± 0.34	0.143	0.886
LDL-C/（mmol/L）	2.98 ± 0.49	3.15 ± 0.58	1.453	0.149
AST/（U/L）	30.65 ± 5.06	31.27 ± 5.45	0.551	0.583
ALT/（U/L）	22.94 ± 4.15	23.11 ± 4.39	0.187	0.852
血肌酐/（mg/L）	1.68 ± 0.34	1.74 ± 0.49	0.631	0.529
NT-proBNP/（pg/mL）	2 301.36 ± 273.64	2 243.48 ± 241.35	1.093	0.277

指标	β	SE	wald χ²	OR值	95%CI	P值
年龄	0.032	0.021	2.390	1.033	0.991 ~ 1.076	0.132
心房颤动	0.729	0.452	2.605	2.074	0.855 ~ 5.030	0.107
PAPi	-0.257	0.089	8.369	0.773	0.649 ~ 0.920	0.004
心肌缺血总负荷	0.745	0.216	11.905	2.107	1.380 ~ 3.218	0.001
CSI评分	0.863	0.312	7.656	2.371	1.286 ~ 4.370	0.006

Predictive value of combined pulmonary artery pulsatility index and myocardial microcirculation indicators for major adverse cardiovascular events in elderly patients with chronic heart failure with reduced ejection fraction

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