肥厚型心肌病患者心房颤动发生情况与易患因素

The incidence and predictors of atrial fibrillation in hypertrophic cardiomyopathy

目的观察肥厚型心肌病（HCM）患者心房颤动（房颤）发生情况与易患因素。方法连续人选1990年7月至2007年11月在我院就诊的HCM患者612例，男414例，女198例，年龄（47．8±14．9）岁，记录临床情况和房颤的发生。结果HCM梗阻型（HOCM）377例（61．6％）。94例（15．4％）患者发生房颤，特点为女性比例较大，年龄偏大，病史较长，心功能状态较差，左心房内径（LAD）明显扩大，血浆B型利钠肽（BNP）水平较高。logistic回归分析显示LAD（P=0．0001），BNP水平（P=0．017）和病史（P=0．012）与HCM患者发生房颤独立相关。房颤加重临床症状，增加栓塞事件。结论HCM患者有较高的房颤发生率，LAD、BNP和病史是HCM房颤发生的独立危险因素。

Objective To observe the incidence and predictors of atrial fibrillation in hypertrophic cardiomyopathy（ HCM ）. Methods 612 HCM patients were analyzed prospectively from July 1990 to November 2007. The age, sex, height, weight, medical history, main symptoms and incidence of atrial fibrillation were recorded. Results The patients＇ mean age was （47.8 ± 14.9）. 414 patients （67.6%） were male. 377 patients（61.6% ） had left ventricular outflow truct obstruction. 94 patients（ 15.4% ） and atrial fibrillation. 43 patients （6.0%） had sustained and 51 patients（9.4% ） had paroxysmal. The patients with atrial fibrillation were older in age and were predominantly female. Their medical history were longer, left atrial diameter （LAD） longer and plasma B-type natriuretic peptide （BNP） higher, logistic regression analysis indicated that the medical history （ P = 0. 012） , LAD （P = 0. 0001 ） and BNP （ P = 0. 017 ） were the independent predictors of atrial fibrillation in HCM. Atrial fibrillation was accompanied by a decrease in functional status and an increase in risk of stroke. Conclusions The incidence of atrial fibrillation in HCM was high. The medical history, LAD and BNP were the independent predictors of its occurrence.