超声心动图LAD、IVST、LVPWT值对原发性高血压并发心房颤动的预测价值

Predictive value of LAD,IVST and LVPWT by ultrasonic cardiogram on atrial fibrillation with essential hypertension

目的分析超声心动图左心房内径(LAD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)对原发性高血压(EH)并发心房颤动(AF)的预测价值。方法回顾性分析2018年10月至2019年10月河南科技大学第一附属医院收治的78例EH患者临床资料,根据其是否合并AF分为EH组(52例)和EH+AF组(26例);将同期30例健康体检者纳入对照组。比较三组受试者超声心动图(UCG)左心结构值及左室收缩功能部分值检测结果差异,应用受试者工作特征曲线(ROC曲线)评价LAD、IVST、LVPWT、左室收缩末期内径(LVESd)、左室舒张末期内径(LVEDd)单独检测对EH合并AF的临床预测价值。对EH合并AF患者进行为期1年的随访,记录主要心血管不良事件发生情况,将其分为发生组及未发生组,比较LAD、IVST、LVPWT、LVESd、LVEDd;采用Spearman相关分析EH合并AF患者LAD、IVST、LVPWT、LVESd、LVEDd与心血管不良事件发生的关系。结果EH+AF组LAD、IVST、LVPWT均大于EH组、对照组,且上述指标EH组均大于对照组(P<0.05),EH+AF组及EH组LVESd、LVEDd均大于对照组(P<0.05),而两组组间LVESd、LVEDd比较差异未见统计学意义(P>0.05);三组每搏输出量(SV)、心排血量(CO)比较差异未见统计学意义(P>0.05);EH+AF组射血分数(LVEF)小于EH组、对照组(P<0.05),EH组与对照组LVEF比较差异未见统计学意义(P>0.05);LAD ROC曲线显示曲线下面积(AUC)为0.800(P<0.05),IVST ROC曲线显示AUC为0.831(P<0.05),LVPWT ROC曲线显示AUC为0.880(P<0.05),LVESd ROC曲线显示AUC为0.510(P>0.05),LVEDd ROC曲线显示AUC为0.561(P>0.05);心血管不良事件发生组LAD、IVST、LVPWT均明显高于未发生组(P<0.05),两组LVESd、LVEDd比较差异未见统计学意义(P>0.05);Spearman相关检验分析显示,EH合并AF患者LAD、IVST、LVPWT与心血管不良事件发生呈明显正相关(P<0.05),LVESd、LVEDd和心血管不良事件发生未见相关性(P>0.05)。结论EH及AF发生时,患者的左心结构亦发生改变,EH+AF患者UCG左心结构部分值变化更显著,早期检测对其诊断及心血管不良事件的发生均具有良好预测价值。

Objective To analyze the predictive value of left atrial diameter(LAD),interventricular septum thickness(IVST)and left ventricular posterior wall thickness(LVPWT)by ultrasonic cardiogram on atrial fibrillation(AF)with essential hypertension(EH).Methods The clinical data of 78 patients with EH admitted to the First Affiliated Hospital of Henan University of Science and Technology from October 2018 to October 2019 were retrospectively analyzed.According to whether they were combined with AF,they were divided into EH group(n=52)and EH+AF group(n=26).Another 30 healthy examiners at the same time period were included in control group.The detection results of ultrasonic cardiogram(UCG)of left ventricular structure values and left ventricular systolic function values were compared among the three groups.Receiver operating characteristic(ROC)curve was used to evaluate the clinical predictive value of LAD,IVST,LVPWT,left ventricular end systolic diameter(LVESd)and left ventricular end diastolic diameter(LVEDd)in EH patients with AF.Patients with EH complicated with AF were followed up for 1 year,and the occurrence of major adverse cardiovascular events were recorded,and the patients were divided into occurrence group and non-occurrence group.LAD,IVST,LVPWT,LVESD and LVEDD were compared.Spearman correlation analysis was used to analyze the relationship between LAD,IVST,LVPWT,LVESD and LVEDD and occurrence of adverse cardiovascular events in patients with EH complicated with AF.Results The LAD,IVST and LVPWT in EH+AF group were higher than those in EH group and control group,and the above indexes in EH group were higher than those in control group(P<0.05),and the LVESD and LVEDD in EH+AF group and EH group were higher than those in control group(P<0.05),but there were no statistical differences in LVESD and LVEDD between the two groups(P>0.05).There was no significant difference in stroke volume(SV)and cardiac output(CO)among the three groups(P>0.05).The left ventricular ejection fraction(LVEF)in EH+AF group was lower than that in EH group and control group(P<0.05),and there was no significant difference in the LVEF between EH group and control group(P>0.05).The AUC of LAD was 0.800(P<0.05),0.831 of IVST(P<0.05),0.880 of LVPWT(P<0.05),0.510 of LVESd(P>0.05)and 0.561 of LVEDd(P>0.05).LAD,IVST and LVPWT in occurrence group of adverse cardiovascular events were significantly higher than those in non-occurrence group(P<0.05),but there were no statistical differences in LVESd and LVEDd between the two groups(P>0.05).Spearman correlation analysis showed that LAD,IVST and LVPWT in patients with EH and AF were significantly positively correlated with the occurrence of adverse cardiovascular events(P<0.05),and the LVESd and LVEDd were not correlated with the occurrence of adverse cardiovascular events(P>0.05).Conclusions There are changes in left ventricular structure of patients with EH and AF,and there are more significant changes of UCG left ventricular structure of EH+AF patients,and early detection has good predictive value in the diagnosis and occurrence of adverse cardiovascular events.