非瓣膜性心房颤动患者心脏舒张功能与CHA2DS2-VASc评分的相关性及其临床意义

Correlation of cardiac diastolic function with CHA2DS2-VASc score in patients with nonvalvular atrial fibrillation and its clinical significance

目的探讨非瓣膜性心房颤动(NVAF)患者心脏舒张功能与血栓风险评估策略CHA2DS2-VASc评分的关系及其临床意义。方法纳入440例NVAF患者,按CHA2DS2-VASc评分分为0分组(31例)、1分组(73例)、2~4分组(138例)、5~7分组(153例)、8~9分组(45例)。比较各组间心脏超声心动图相关指标。采用混合设计双因子变异数分析NVAF患者心脏舒张功能与CHA2DS2-VASc评分和高血压的关系。以CHA2DS2-VASc评分≥2分为评价NVAF患者存在高血栓栓塞风险的标准,应用Logistic回归模型分析心脏舒张功能指标对NVAF患者血栓栓塞风险的预测作用。结果不同CHA2DS2-VASc评分患者心脏超声心动图左房前后径、二尖瓣环舒张早期血流速度(e')、二尖瓣口充盈早期峰值血流速度(E)/e'、左房体积指数(LAVI)差异有统计学意义(均P<0.05)。混合设计双因子变异数分析结果显示,心脏舒张功能指标LAVI、E/e'与CHA2DS2-VASc评分相关(P<0.05),并且这种相关性独立于高血压及该评分与高血压的交互作用。Logistic回归分析结果显示,e'降低、LAVI和E/e'升高与CHA2DS2-VASc评分≥2分相关,为预测NVAF患者高血栓栓塞风险的有效指标(P<0.05)。结论NVAF患者的心脏舒张功能与CHA2DS2-VASc评分相关,其可能在评估NVAF患者发生血栓栓塞事件风险中起重要作用。

Objective To investigate the association between cardiac diastolic function and thrombotic risk assessment strategy CHA2DS2-VASc score in patients with nonvalvular atrial fibrillation(NVAF)and its clinical significance.Methods Totally 440 patients with NVAF were enrolled,and were divided into 0 point group(31 cases),1 point group(73 cases),2-4 points group(138 cases),5-7 points group(153 cases)and 8-9 points group(45 cases)according to CHA2DS2-VASc scores.The relevant cardiac echocardiographic parameters were compared between groups.The two-factor analysis of variance with mixed design was applied to the relation of cardiac diastolic function with CHA2DS2-VASc score and hypertension in NVAF patients.CHA2DS2-VASc score≥2 was defined as high-risk of thromboembolism in NVAF patients,then Logistic regression model was employed to analyze the predictive effect of cardiac diastolic function indicators for risk of thromboembolism in NVAF patients.Results There were statistically significant differences in left atrial anteroposterior diamete,early diastolic flow velocity of mitral annulus(e'),peak flow velocity of mitral annulus at early filling period(E)/e',and left atrial volume index(LAVI)on cardiac echocardiography among patients with different CHA2DS2-VASc scores(all P<0.05).The two-factor analysis of variance with mixed design results showed that diastolic function indicators LAVI,E/e'correlated with CHA2DS2-VASc score(all P<0.05),and this correlation was independent of hypertension and the interaction between the score and hypertension.Logistic regression analysis results revealed that reduction of e'and elevation of LAVI or E/e'correlated with CHA2DS2-VASc score≥2(all P<0.05),and were the effective indicators for predicting high-risk of thromboembolism in NVAF patients(P<0.05).Conclusion Cardiac diastolic function is associated with CHA2DS2-VASc score in NVAF patients,which may play an important role in assessing the risk of thrombotic events in patients with NVAF.