慢性心力衰竭患者左心房结构及功能与近期心血管不良事件的关系

Correlation between left atrial function and short term prognosis in patients with chronic heart failure

目的探讨慢性心力衰竭患者左心房结构及功能与近期心血管不良事件的关系。方法入选慢性心力衰竭患者92例,治疗随访3个月,彩色多普勒超声检查左心房结构及功能变化,观察各种原因死亡、心力衰竭再加重住院的发生率,另设健康对照组30例,进行观察比较。结果心力衰竭患者92例中,失访6例,事件组23例,非事件组63例。(1)左心房结构变化:与健康对照组比较,心力衰竭组患者左心房最大容积(LAV_(max))、P容积(LAV_p)及最小容积(LAV_(min))等各结构指标均扩大(P<0.01);与非事件组患者比较,事件组左心房各结构指标均进一步扩大(P<0.05)。(2)左心房功能变化:与健康对照组比较,心力衰竭组患者的左心房存储容积(LARV)、左心房主动排空容积(LASV)、左心房主动排空分数(LAAEF)有不同程度的升高(P<0.01),而左心房管道容积(LACV)则减低(P<0.01);与非事件组患者比较,事件组LAAEF、LACV均减低(P<0.05),而LASV、LARV无显著变化(P>0.05)。结论超声检测左心房结构及功能指标是预测慢性心力衰竭患者近期心血管不良事件的较好指标。

Objective To observe the relationship between chronic heart failure patients with left atrial structure and function and the recent adverse cardiovascular events. Methods Ninty-two patients of chronic heart failure were enrolled, all patients were followed up for 3 months, changes of left atrial structure and function were detected by ultrasound, death from all causes, and then aggravate of heart failure and the incidence of hospitalization were recorded, another 30 healthy as control group, they were observed and compared. Results In 92 cases of patients with heart failure, 6 cases were lost of follow-up, event group were 23 cases, non-event group of 63 cases. （ 1 ） Left atrial structural change： compared with health control group, the left atrium in patients with congestive heart failure （LAVmmax） , P volume （LAVp） , the minimum volume （LAVmin ） and other structural indicators are expanding （ P 〈 0.01 ） ; compared with the non-event group, event groupg indexes of left ventricular structure were further expanded （ P 〈 O. 05 ）. （2） The changes of left atrial function ： compared with health con- trol group, left atrial volume storage （LARV）, left atrial emptying volume （LASV）, left atrial emptying fraction （LAAEF） in patients with heart failure were increased in different degrees （ P 〈0. O1 ）, and left atrial conduit volume （LACV） were de- creased （ P 〈 0.01 ） ; compared with the non-event group, LAAEF, LACV were decreased in the event group （ P 〈 0.05 ）, while LASV, LARV had no significant change （ P 〉 O. 05 ）. Conclusion Ultrasonic detection of left atrial strticture and function in patients with chronic heart failure is a better predictor of recent adverse cardiovascular events.