中重度功能性三尖瓣反流程度与心房颤动的关系

Association of atrial fibrillation with severity of functional tricuspid regurgitation

目的分析中重度功能性三尖瓣反流(FTR)程度与是否合并心房颤动、心房颤动持续时间的相关性及其影响因素。方法收集2013年1月至2017年1月收治的中重度FTR患者共142例,根据有无心房颤动及心房颤动持续时间分为慢性心房颤动组(42例)、阵发性心房颤动组(30例)及窦性心律组(70例)。比较3组患者在性别、年龄、高血压病史、冠心病病史、脑梗死病史和是否合并肺动脉高压上的区别;评估超声心动图检查结果,包括左心室舒张末期内径(LVDd)、右心室舒张末期内径(RVDd)、右心房舒张末期内径(RADd)、左心室射血分数(LVEF)、三尖瓣瓣环直径及瓣叶闭合高度等。结果与阵发性心房颤动组和窦性心律组比较,慢性心房颤动组年龄较大(均P<0.05),合并高血压病、冠心病、脑梗死和肺动脉高压患者的比例明显升高(均P<0.05);与阵发性心房颤动组和窦性心律组比较,慢性心房颤动组的RVDd、RADd、三尖瓣环直径及闭合高度均升高(均P<0.05),LVDd及LVEF无统计学差异。结论三尖瓣瓣环径扩大、右室功能降低均是FTR的重要影响因素,心房颤动周期长短对中重度FTR的影响最为重要。

Objective To explore the association of atrial fibrillation （AF） with the severity of functional tricuspidregurgitation （FTR）. Methods One hundred and forty two patients with moderate to severe functional tricuspid admitted inout hospital from January 2013 to January 2017 were recruited in the study. According to history of atrial fibrillation thepatients were divided into chronic AF group（n=42）, paroxysmal AF group（n=30） and sinus rhythm group（n=70）. The gender,age, history of hypertension, coronary heart disease and cerebral infarction, and complication of pulmonary hypertensionwere compared among three groups. The echocardiography was performed, the parameters including left ventricular enddiastolic diameter （LVDd）, right ventricular end diastolic diameter （RVDd）, right atrial end diastolic diameter （RADd）, leftventricular ejection fraction（LVEF）, tricuspid annulus diameter, and leaflet closure height were compared. Results Comparedwith the paroxysmal AF group and the sinus rhythm group, the mean age, and the proportion of patients with hypertension,coronary heart disease, cerebral infarction, and pulmonary hypertension of the chronic AF group were significantly higher（P〈0.05）. The RVDd, RADd, tricuspid annulus diameter, and closure height were significantly elevated in the chronic AF group（P〈0.05）; while there was no significant difference in LVDd and LVEF among the groups（P〉0.05）. Conclusion Tricuspid valve ringdiameter expansion, right ventricular function are the factors affecting the tricuspid regurgitation, and the length of the duration ofatrial fibrillation is the most important affecting factor.