转复窦性心律对非缺血性心肌病合并非瓣膜病心房颤动患者左心室功能及结构的短期影响

Short-term effect of sinus rhythm restoration on left ventricular function and structure in patients with nonischemic cardiomyopathy combined with nonvalvular atrial fibrillation

目的探讨转复维持窦性心律(下称窦律)对非缺血性心肌病(NICM)合并非瓣膜病心房颤动(NVAF)患者左心室功能及结构的短期影响。方法2015年5月至2020年9月期间宁波市第一医院和宁波市镇海区人民医院收治的31例左心室射血分数(LVEF)≤35%的NICM合并NVAF患者经药物或直流电复律治疗,随访3~6个月后18例维持窦律(窦律组),13例房颤复发(复发组),比较两组超声心动图指标和纽约心脏病协会(NYHA)心功能分级变化。结果在随访第3、6个月,窦律组LVEF、LVEF>35%比例、纽约心脏病协会(NYHA)Ⅱ级比例均明显高于复发组(均P<0.05),而左心室舒张末期内径(LVEDd)、左心房内径(LAD)均低于复发组(均P<0.05);与复律前比较,在随访第3、6个月窦律组LVEF及NYHAⅡ级比例均明显升高(均P<0.05),LVEDd、LAD均明显降低(均P<0.05),随访期间窦律组电复律比例明显低于复发组(P<0.05)。结论复律后短期内,多数LVEF≤35%的NICM合并NVAF患者的左心室功能和结构得到明显改善。

Objective To investigate the short-term effect of sinus rhythm(SR)restoration on left ventricular function and structure in patients with nonischemic cardiomyopathy(NICM)and nonvalvular atrial fibrillation(NVAF).Methods Thirty-one NICM-NVAF patients with left ventricular ejection fraction(LVEF)≤35%underwent chemical or electrical cardioversion in Ningbo First Hospital and Zhenhai District People's Hospital of Ningbo from May 2015 to September 2020.During follow-up 3 to 6 months,18 cases were in SR(SR group)and 13 cases had AF recurrence(AF group).The changes of echocardiographic parameters and New York Heart Association(NYHA)functional class were compared between the two groups.Results At 3th month and 6th month after cardioversion,LVEF,the percentage of cases with LVEF>35%and NYHA functional classⅡwere significantly higher,left ventricular end-diastolic diameter(LVEDd)and left atrial diameter(LAD)were significantly lower in SR group than in AF group(all P<0.05).LVEF and the percentage of NYHA functional classⅡincreased,LVEDd and LAD decreased significantly at 3th month and 6th month after cardioversion than before cardioversion in SR group(all P<0.05).Electrical cardioversion was less performed in SR group than in AF group during follow-up(P<0.05).Conclusion Left ventricular function and structure are improved obviously in most of the patients with NICM-NVAF and LVEF≤35%at short-term follow-up after SR restoration.