左室限制性充盈障碍与急性心肌梗死新发房颤的关系研究

Relationship between left ventricular restrictive filling dysfunction and risk of new-onset atrial fibrillation after acute myocardial infarction

目的研究左室限制性充盈障碍与急性心肌梗死（AMI）新发心房颤动（房颤）的关系。方法回顾性分析AMI患者288例,患者住院后1~3 d均行超声心动图检查。根据是否有新发房颤分为房颤组和非房颤组。对两组患者的性别、年龄、梗死部位、心功能分级、危险因素、冠状动脉病变支数、药物应用等临床特征及左室射血分数、左房内径、E/A比值等超声心动图参数进行比较,并对临床及超声心动图参数与新发房颤的关系进行了单因素及多因素logistic回归分析。结果入选患者中新发房颤发生率14.2%（42/288）。两组患者临床及超声指标比较,房颤组女性比例、平均年龄、Killip分级≥Ⅱ级比例、左心房内径、左室限制性充盈障碍的比例、利尿剂使用率、冠状动脉三支病变的比例均高于非房颤组患者（P〈0.05~0.01）。多因素Logistic回归分析发现年龄〉65岁、左心房内径〉40 mm、Killip分级≥Ⅱ级、左室舒张功能限制性充盈障碍是AMI患者出现新发房颤的独立危险因素,OR值及95%CI分别为2.28（1.78~4.97）,1.71（1.13~2.86）,1.49（1.03~1.74）和2.58（1.64~3.75）。结论左室限制性充盈障碍是急性心肌梗死新发房颤的独立危险因素。

Objective To study the relationship between left ventricular restrictive filling dysfunction and risk of new-onset atrial fibrillation （AF） after acute myocardial infarction （AMI）.Methods The data of 288 AMI patients were retrospectively analyzed, and all patients were given echocardiogram examination within 1 d to 3 d after hospitalization and then divided into AF group and non-AF group. The data of sex, age, infarction position, NYHA grading, risk factor, number of diseased coronary vessels, drug administration, LVEF, LVEDd and ratio of E/A were compared between 2 groups. The relationship between clinical or echocardiogram parameters and new-onset AF were given single factor and multi-factor Logistic regression analysis.Results The incidence of new-onset AF was 14.2% （42/288） in all included patients. The percentages of female patients and patients with Killip≥Ⅱ, left ventricular restrictive filling dysfunction and 3-vessel lesion, average age, LVEDd, diuretics usage rate were all higher in AF group than those in non-AF group （P〈0.05 toP〈0.01）. Logistic regression analysis found that age〉65 （OR=2.28, 95%CI： 1.78~4.97）, LVEDd〉40 mm （OR=1.71, 95%CI： 1.13~2.86）, Killip≥Ⅱ （OR=1.49, 95%CI：1.03~1.74） and left ventricular restrictive filling dysfunction （OR=2.58, 95%CI： 1.64~3.75） were independent risk factors of new-onset AF.Conclusion Left ventricular restrictive filling dysfunction is a independent risk factor of new-onset AF of AMI.