扩张型心肌病患者心房颤动的临床意义

The significance of atrial fibrillation in idiopathic dilated cardiomyopathy

目的：探讨扩张型心肌病（ＤＣＭ）伴发心房颤动（ＡＦ）的临床意义。方法：将１９例ＤＣＭ伴ＡＦ者与５０例ＤＣＭ无ＡＦ者的临床、超声心动图及心电图资料进行对比分析。结果：ＤＣＭ并发ＡＦ者年龄老化〔（６５±１６）岁〕，心功能（ＮＹＨＡⅢ级～Ⅳ级者７８．９５％）差，栓塞率（２１．０５％）和病死率（３６．８４％）均高（Ｐ＜０．０５或Ｐ＜０．０１）；左室射血分数（０．２８±０．０９）、短轴缩短率（０．１５±０．０３）明显降低，心脏扩大发生率、室性心律失常及复合心律失常发生率高（Ｐ＜０．０５或Ｐ＜０．０１）。结论：ＤＣＭ的ＡＦ发生与年龄、心力衰竭、心室扩大、心肌病变相关，ＡＦ是预后不良的指标。

Objective:To study the clinical significance of atrial fibrillation (AF) in idiopathic dilated cardiomyopathy (DCM).Methods:Clinical data,including clinical condition,twodimensional Doppler echocardiographic as well as electrocardiographic findings,were analyzed in 19 cases with AF and 50 cases without AF.Results:The DCM patients complicated with AF were elderly 〔(65±16)years〕,while the clinical cardiac function score (NYHA Ⅲ～Ⅳ 7895%) was obviously lower,and the incidence of embolism (2105%) as well as mortality rate (3684%) were significant increased compared to those without AF(P<005 or P<001).Also,the left ventricular ejection fractions and left ventricular length circumference shortening fractions in AF group (028±009 and 015±003 respectively) were significantly lower than those in the controls.The incidences of ventricular enlargement,ventricular arrhythmia,and complex arrhythmia were higher in AF group compared to nonAF group (P<005 or P<001).Conclusions:DCM with AF seems to be related to old age,congestive heart failure,ventricular dilation,myocardiopathy.AF may be a predictive parameter for the severity of DCM.