Predictors of recovery of normal left ventricular ejection fraction in patients with chronic Keshan disease / 中华地方病学杂志

ABSTRACT

Objective:To explore the predictors of recovery of normal left ventricular ejection fraction (LVEF) in patients with chronic Keshan disease (CKD) after standard anti-heart failure treatment.Methods:From June 2013 to October 2017, CKD patients were selected as the research subjects in 8 Keshan disease counties (cities) in Shandong Province. Demographic data and clinical indicators related to the recovery of normal LVEF were collected at the initial diagnosis, and the patients were given standard anti-heart failure treatment. Follow-up was carried out until October 2019 or until all-cause death. Patients were divided into recovery group and non-recovery group according to whether LVEF returned to normal (LVEF≥50% was normal) by group design, and multi-factor logistic regression was used to analyze the predictors of recovery of normal LVEF.Results:A total of 98 CKD patients were included in this study, their average age was (47.51 ± 12.84) years old; body mass index (BMI) was (23.18 ± 4.92) kg/m 2; LVEF was (39.54 ± 8.26)%; male accounted for 65.31% (64/98); the New York Heart Association (NYHA) heart function grade Ⅱ and grade Ⅲ accounted for 46.94% (46/98) and 53.06% (52/98), respectively. The median follow-up time was 26 months, the LVEF of 28 patients (28.57%) returned to normal, and the LVEF increased from (43.27 ± 7.85)% of the baseline to (58.74 ± 6.07)%, the difference was statistically significant ( t=8.25, P < 0.01); LVEF did not return to normal in 70 patients (71.43%), and the LVEF increased from (37.84 ± 6.93)% of the baseline to (42.94 ± 7.31)%, the difference was statistically significant ( t=4.24, P < 0.01). The median recovery time of 28 patients with normal LVEF recovery was 14 months, of which 4 patients (14.29%), 6 patients (21.43%) and 15 patients (53.57%) recovered at follow-up of 6, 12 and 18 months, respectively, and 27 patients (96.43%) recovered within 3 years. The results of multivariate logistic regression analysis showed that disease course [odds ratio ( OR)=0.81, 95% confidence interval ( CI) 0.70-0.95, P < 0.05], electrocardiogram QRS wave duration ( OR=0.88, 95% CI 0.79-0.98, P < 0.05), LVEF ( OR=1.26, 95% CI 1.13-1.42, P < 0.01), and left ventricular end-diastolic diameter (LVEDD, OR=0.79, 95% CI 0.66-0.90, P < 0.01) were independent predictors of recovery of normal LVEF. Conclusions:LVEF can return to normal after anti-heart failure treatment in some CKD patients. Patients with shorter disease course, shorter electrocardiogram QRS wave duration, higher baseline LVEF and lower LVEDD are more likely to recover from LVEF.