心房颤动对肥厚型心肌病患者长期预后的影响

Influence of atrial fibrillation on long-term prognosis of patients with hypertrophic cardiomyopathy

目的分析心房颤动(房颤)对肥厚型心肌病(hypertrophic cardiomyopathy,HCM)患者长期预后的影响。方法回顾性分析573例HCM患者的临床资料,记录患者病死率、HCM相关死亡因素、心功能状态、心力衰竭再住院率、脑卒中发生情况及抗凝药物应用情况,采用COX回归分析做出生存曲线,分析房颤对HCM患者长期预后的影响。结果 467患者完成随访,随访率81.5%,随访时间6个月～10a;其中123例(26.3%)有阵发性或永久性房颤;随访结束时死亡42例,其中HCM相关死亡31例;房颤患者心功能Ⅲ～Ⅳ级(55.3%)比例高于无房颤患者(21.8%)(P<0.01),脑卒中发生率(22.0%)高于无房颤患者(2.3%)(P<0.01)。结论房颤可增加HCM患者脑卒中发生概率,降低患者心功能状态,降低HCM患者长期生存率。

Objective To analyze the influence of atrial fibrillation （AF） on the long-term prognosis of the patients with hypertrophic eardiomyopathy （HCM）. Methods The clinical data of 573 cases of HCM were analyzed retrospectively to record the overall mortality, HCM related death factors, cardiac function, the rate of readmission due to heart failure, stroke occurrence and the use of anticoagulation drugs. COX regression analysis was used to make survival curve to analyze the influence of atrial fibrillation on the long-term prognosis of HCM. Results A total of 467 patients were followed up （81.5%） for 0.6 to 10 （6.4±2.6） years, among which 123 patients （26.3%） suffered from paroxysmal or permanent AF. At the end of follow up survey 42 patients died, including 31 cases of HCM related death. The proportion of cardiac function of grade Ⅲ to Ⅳ level was higher in patients with AF （55. 3%） than that in patients without AF （21.8%）（P〈0.01）. The incidence of stroke was higher in patients with AF （22.0%） than that in those without AF （2.3%） （P〈0.01）. Conclusion Atrial fibrillation increases stroke risk, and reduces the cardiac function and the long-term survival rate in patients with HCM.