老年心房颤动伴二尖瓣反流患者的临床特点和预后

Clinical manifestation and prognosis of atrial fibrillation with mitral regurgitation in the elderly

目的:探讨老年心房颤动(房颤)伴功能性二尖瓣反流(MR)患者的临床特点和预后。方法:回顾性分析2012年8月—2019年12月于北京大学第一医院老年病内科住院并接受超声心动图检查的年龄≥65岁、房颤伴左房增大、二尖瓣运动及形态正常、MR患者的临床资料。根据MR程度,分为轻度、中度、重度3组,分析组间临床指标及超声心动图指标差异。随访记录全因死亡及因心力衰竭(心衰)再住院的事件,进行Kaplan-Meier生存分析和多因素Cox回归分析。结果:入选120例患者,中位年龄86岁。重度MR组女性、NYHAⅣ级占比明显高于轻度和中度MR,重度MR组左室射血分数明显低于轻度和中度MR组;重度MR组BMI明显低于轻度MR组;重度MR组脑钠肽、收缩期三尖瓣反流峰值速度、肺动脉收缩压明显高于轻度MR组。在中位时间为26个月的随访中,44例(38.9%)发生全因死亡,37例(32.7%)因心衰再住院。3组间全因死亡率、因心衰住院率有显著差异(Log Rank P=0.042、0.006)。随着MR程度增加,全因死亡率、因心衰再住院率增加(P<0.05)。多因素COX回归分析显示,NHYA分级(HR:1.924,95%CI:1.293~2.863,P=0.001)、MR程度(HR:1.717,95%CI:1.032~2.856,P=0.037)与因心衰再住院相关。结论:老年房颤伴功能性MR患者,随着MR程度增加,全因死亡率、因心衰再住院率增加。NYHA分级、MR程度是老年房颤患者因心衰再住院的危险因素。

Objective:To investigate the clinical characteristics and prognosis of atrial fibrillation with functional mitral regurgitation(MR)in elderly.Methods:The clinical data were retrospectively analyzed in elderly patients(older than 65)with atrial fibrillation,enlarged left atrium and MR in the Department of Geriatrics in Peking University First Hospital from August 2012 to December 2019.The patients were divided into mild,moderate and severe groups according to the degree of MR.The differences of clinical and echocardiographic indexes of the three groups were analyzed.Kaplan-Meier survival analysis and multivariate Cox regression analysis were performed.Results:A total of 120 patients were involved,with a median age of 86-year-old.The proportions of female and NYHA grade IV in severe MR group were significantly higher than those in mild and moderate MR group.LVEF in severe MR group was significantly lower than that in mild and moderate MR group.BMI in severe MR group was significantly lower than that in mild MR group.BNP,TRPV and PASP in severe MR group were significantly higher than those in mild MR group.During a median follow-up of 26 months,there were 44 cases(38.9%)of call-cause death,37 cases(32.7%)of readmission for heart failure.There were significant differences in all-cause mortality and readmission for heart failure among the three groups(Log rank P=0.042,0.006).With the increase of MR degree,all-cause mortality and readmission for heart failure increased(P<0.05).Multivariate Cox regression analysis showed that NHYA grade(HR:1.924,95%CI:1.293-2.863,P=0.001)and MR degree(HR:1.717,95%CI:1.032-2.856,P=0.037)were associated with hospitalization for HF.Conclusion:In elderly patients with atrial fibrillation and functional mitral regurgitation,all-cause mortality and readmission for heart failure increased with the increase of MR degree.NYHA grade and MR degree were risk factors of readmission for heart failure in elderly patients with atrial fibrillation.