风湿性心脏病二尖瓣狭窄并发房颤的相关因素研究

Study on the related factors of mitral stenosis complicated with atrial fibrillation in rheumatic heart disease

目的应用超声心动图评价风湿性心脏病(简称风心病)二尖瓣狭窄并发房颤的心内结构及血流动力学特点,探讨风心病房颤发生的相关因素。方法回顾分析99例风心病二尖瓣狭窄患者超声心动图及临床资料,根据有无持续性房颤分为:房颤组(AF组,n=51)和窦律组(SR组,n=48),将超声心动图主要指标进行统计学分析。结果与SR组比较,AF组左房前后径(LAD)、左室舒张期末径(LVEDD)均增大,而左室射血分数(LVEF)降低,二尖瓣口面积(MVA)减小,差异均有统计学意义(P<0.05)。Pearson相关性分析显示LAD与LVEDD、二尖瓣血流峰值速度(Vmax)呈正相关(r=0.491,P<0.01;r=0.467,P<0.01);LAD与LVEF、二尖瓣口面积(MVA)呈负相关(r=-0.215,P<0.05;r=-0.218,P<0.05);LVEDD与LVEF呈负相关(r=-0.282,P<0.01),LVEF与MVA呈正相关(r=0.213,P<0.05)。结论风心病二尖瓣狭窄患者房颤的发生与二尖瓣口面积、左房及左室内径扩大程度、左室心功能密切相关。左室收缩功能与二尖瓣面积、房颤、左房大小关系密切。

Objective To evaluate the intracardiac structure and hemodynamic characteristics of rheumatic heart disease with mitral stenosis and atrial fibrillation by echocardiography ao as to explore the related factors of rheumatic with atrial fibrillation. Methods The echocardiography and clinical data of 99 patients with rheumatic mitral stenosis were retrospectively analyzed. According to the presence or absence of persistent atrial fibrillation, patients were divided into AF group ( n = 51) and sinus rhythm (SR) group ( n = 48). The main indicators of echocardiography were snbjected to statistical analysis. Results Compared with SR group, left atrial diameter (LAD) and left ventricular end diastolic diameter (LVEDD) was increased in group AF, while left ventricular ejection fractions (LVEF) and mitral valve area (MVA) in AF group were lower and smaller than those in SR group, both P <0.05. Pearson correlation analysis showed that LAD was positively related to LVEDD and Doppler mitral valve peak velocity (Vmax )( r =0.491, P <0.01;r =0.467, P <0.01)), negatively related to LVEF and mitral valve orifice area (MVA)( r =-0.215, P <0.05;r =-0.218, P <0.05);LVEDD was negatively related to LVEF ( r =-0.282, P <0.01);and LVEF was positively related to MVA ( r =0.213, P <0.05). Conclusion The occurrence of atrial fibrillation in patients with mitral stenosis of rheumatic heart disease is closely related to mitral valve area, the extent of enlargement of left atrium and left ventricular and left ventricular function. Left ventricular systolic function is closely related to mitral valve area, atrial fibrillation, and left atrial size.