无创检查可预测器质性心脏病房颤的发生

Prediction of atrial fibrillation in patients with organic heart disease by non-invasive examination

目的 研究无创检查对器质性心脏病房颤的预测。方法 总结我院近 5年来收治的 15 4例器质性心脏病患者的超声心动图及心电图检查资料 ,进行回顾性研究。测量 6 8例房颤组患者和 86例非房颤组患者的左房内径(LAD)、左室内径 (LVD)、左室射血分数 (LVEF)、左室舒张功能、最大P波 (Pmax)、最小P波 (Pmin)、P波离散度(pd)。 结果 两组病例 (房颤组vs非房颤组 ) :LAD(43.0 7± 6 .77)mmvs(36 .96± 5 .5 4 )mm、Pmax(12 3.0 7± 9.94 )msvs(113.0 1± 10 .86 )ms、Pd(6 3.6 5± 9.4 9)msvs(5 2 .6 1± 11.82 )ms,差异有统计学意义 (均为P <0 .0 0 1) ;年龄(6 9.5± 8.3)岁vs(6 5 .9± 11.1)岁 ,差异有统计学意义 (P <0 .0 5 ) ;左室舒张功能、P波离散度及左房内径与房颤关系密切。结论 测量窦性心律时左室舒张功能、P波离散度及左房内径可以预测器质性心脏病房颤的危险。

Objective To investigate whether the patients with organic heart disease at risk for paroxysmal atrial fibrillation (AF) could be detected by non-invasive examination while in sinus rhythm.Methods A computer-based 12-lead surface electrocardiogram was recorded ,the left atrial diameter (LAD),left ventricuar diameter (LVD) and left ventricuar ejection fraction (LVEF) were measured using electronic callipers by echocardiography in 68 organic heart disease patients with history of paroxysmal AF (group AF) and in 86 organic heart disease without history of AF (group no-AF).The maximum P-wave duration (Pmax),the minimum P-wave duration (Pmin),P-wave dispersion (Pd=Pmax-Pmin) were calculated.Results Group AF vsgroup no-AF LAD( 43.07± 6.77) vs( 36.96± 5.54)mm,Pmax( 123.07± 9.94) vs( 113.01± 10.8)ms,Pd,( 63.65± 9.49) vs( 52.61± 11.82) ms,P< 0.001,Age ( 69.5± 8.3) vs( 65.9± 11.1) year-old P< 0.05,all were significantly higher in group AF than in group no-AF.Diastolic function,Pd,LAD were predictor factors of paroxysmal AF in Logistic regression analysis.Conclusion The patients with organic heart disease at risk for paroxysmal AF could be detected while in sinus rhythm by analysis of computer-based electrocardiographic P-wave and measuring echocardiogram.