超声检查对肥厚型心肌病病人发生心房颤动的预测价值

Ultrasonic parameters as a predictor for atrial fibrillation development in patients with hypertrophic cardiomyopathy

目的评价超声检查对肥厚型心肌病病人发生心房颤动的预测价值。方法选取2013年1月至2017年3月济宁医学院附属医院就诊的肥厚型心肌病病人作为研究对象,收集病人临床资料及超声检查结果;根据随访期间有无新发房颤将研究对象分为房颤组和无房颤组,比较其临床特点并采用多因素logistic回归分析肥厚型心肌病病人发生房颤的危险因素。结果共321例肥厚型心肌病病人入选,其中发生房颤38例。房颤组与无房颤组在年龄[(51.47±10.98)比(45.54±11.84)岁]、最大室壁厚度(21.0比17.0 mm)、左房面积(32.0比19.0 cm^2)、二尖瓣舒张早期血流速度与二尖瓣环运动速度之比(E/e’)(18.0比11.5)及肺动脉收缩压(32.0比30.0 mmHg)均差异有统计学意义(均P<0.05)。多因素logistic回归分析发现,E/e’和左房面积是肥厚型心肌病病人房颤发生的独立危险因素。ROC曲线显示左房面积和E/e’的最佳截断点分别为28 cm^2和17。结论E/e’≥17和左房面积≥28 cm2是肥厚型心肌病病人发生房颤的独立预测因子。

Objective To explore the ultrasonic predictors of atrial fibrillation in patients with hypertrophic cardiomyopathy(HCM).Methods Patients with HCM in our hospitalized fromJanuary 2013 to March 2017 were enrolled.Each patient underwent examina?tions including transthoracic echocardiography,body surface electrocardiograph or dynamic electrocardiogram(Holter).The subjects were divided into two groups(the AF group and non?AF group).Risk factors for AF in patients with HCM were assessed by multi?variate logistic regression analysis.Results Univariate analysis showed that the factors associated with the development of new?on?set AF were age[(51.47±10.98)vs.(45.54±11.84)],maximum myocardial thickness(21.0 vs.17.0 mm),atrial area(32.0 vs.19.0 cm2),E/e’(18.0 vs.11.5),and pulmonary artery systolic pressure(PASP)(32.0 vs.30.0 mmHg)estimated by echocardiogra?phy.After performingmultivariate analysis,only E/e’≥17 and atrial area remained statistically significant.Conclusion An E/e’≥17 and LA area≥28 cm2 are strong and independent predictors of AF.