COX-MAZE Ⅳ手术同期心脏瓣膜手术心脏左房前后径和NT-proBNP的变化

Changes of left atrial diameter and NT-proBNP in patients with COX-MAZE Ⅳ procedure concomitant valvular surgery

目的:研究左房前后径和血浆氨基末端脑利钠肽(NT-probriain natriuretic peptide,NT-proBNP)浓度在COX-MAZEⅣ手术同期心脏瓣膜手术治疗持续性瓣膜性房颤患者术前术后的变化。方法:持续不间断地纳入32例持续性瓣膜性房颤的患者(房颤组)行COX-MAZEⅣ手术同期心脏瓣膜手术,同期窦性心律患者单纯性心脏瓣膜手术(窦性心律)18例为对照组。房颤组再根据术后心律,分为房颤-窦性组19例,房颤-房颤组13例。术前、术后6个月分别行心电图,24 h心电图,检测心律状态,行心脏超声,测量左房前后径和左室射血分数(left ventricular ejection fraction,LVEF),检测血浆NT-proBNP浓度。结果:房颤组和窦性组比较,术前左房前后径有统计学差异[(53.53±9.48)mm vs.(41.11±6.31)mm,P=0.000],LVEF无统计学差异[(52.53±7.03)%vs.(58.00±5.87)%,P=0.07)],血浆NT-proBNP浓度有统计学差异[(2792±1582)pg/mL vs.(1035±833)pg/mL,P=0.000]。房颤-窦性组和房颤-房颤组比较,术前左房前后径有统计学差异[(49.90±1.70)mm vs.(58.85±9.92)mm,P=0.007],术前LVEF无统计学差异[(53.37±1.49)%vs.(51.31±7.83)%,P=0.424],术前血浆NT-proBNP有统计学差异[(2298±261)pg/mL vs.(3514±1892)pg/mL,P=0.03]。术后6个月左房前后径有统计学差异[(41.84±1.12)mm vs.(48.23±8.12)mm,P=0.009],术后6个月LVEF有统计学差异[(58.58±0.62)%vs.(54.08±5.47)%,P=0.04],术后6个月血浆NT-proBNP有统计学差异[(489±84)pg/mL vs.(1408±1176)pg/mL,P=0.017]。结论:左房前后径增大,血浆NT-proBNP浓度升高是瓣膜疾病并发房颤的危险因子。年龄、左房前后径增大、血浆NT-proBNP升高是瓣膜手术同期COX-MAZEⅣ手术术后房颤的复发高危因子。而术后6个月的左房前后径、左室射血分数、血浆NT-proBNP浓度与术后窦性心律的维持有关。

Objective:To access the changes of left atrial diameter and NT-proBNP in patients with COX-MAZEⅣprocedure concomitant valvular surgery.Methods:A total of 50 patients were consecutively recruited and divided into 3 groups:sinus group,AF-sinus group,AF-AF group.Left ventricular ejection fraction(LVEF)and left atrial diameter were measured by echocardiography before and6 months after procedure.Plasma NT-proBNP levels were measured before and 6 months after procedure.Results:The left atrial diameters before procedure were significantly different between sinus group and AF group[(53.53±9.48)mm vs.(41.11±6.31)mm,P=0.000].The plasma NT-proBNP levels were also significantly different[(2792±1582)pg/mL vs.(1035±833)pg/mL,P=0.000].But the LVEF values were not[(52.53±7.03)%vs.(58.00±5.87)%,P=0.07].The left atrial diameters before procedure were different between AF-sinus group and AF-AF Group[(49.90±1.70)mm vs.(58.85±9.92)mm,P=0.007]and the plasma NTproBNP levels were also differene[(2298±261)pg/mL vs.(3514±1892)pg/mL,P=0.03].The LVEF values were not[(53.37±1.49)%vs.(51.31±7.83)%,P=0.424].The left atrial diameters after 6 months procedure were different between AF-sinus group and AF-AF group[(41.84±1.12)mm vs.(48.23±8.12)mm,P=0.009]and the plasma NT-proBNP levels were different[(489±84)pg/mL vs.(1408±1176)pg/mL,P=0.017].The LVEF values were also different[(5408±5.47)%vs.(58.58±0.62)%,P=0.04].Conclusion:The left atrial diameters and the plasma NT-proBNP levels are the risk factors of occurrence of AF in patients with valvular diseases.The more left atrial diameters and the plasma NT-proBNP levels before procedure tend to AF recurrence and the less left atrial diameters and the plasma NT-proBNP levels,the more LVEF values are beneficial to sinus rhythm restoration.