非瓣膜性房颤并射血分数保留心衰患者超声心动图指标与NT-proBNP的相关性

Correlation analysis of echocardiographic parameters and NT-proBNP in patients with nonvalvular atrial fibrillation and ejection fraction preserved heart failure

目的分析非瓣膜性房颤并射血分数保留心衰患者超声心动图指标与N末端脑钠肽前体(NT-proBNP)的相关性,为临床诊断提供依据。方法回顾性分析2011年6月至2019年6月在揭阳市人民医院心内科接受治疗的100例非瓣膜性房颤并射血分数保留心衰患者的临床资料,根据患者的房颤发作情况分为阵发性房颤组43例和持续性房颤组57例,同期选择50例不伴有房颤的射血分数保留心衰者作为对照组。比较三组患者的左房内径、左心房容积指数、二尖瓣舒张早期血流峰速度(E)/二尖瓣环舒张早期运动峰速度(Em)、左心室射血分数(LVEF)、NT-proBNP及肾小球滤过率(eGFR)的差异,并使用Spearman相关性分析法分析NT-proBNP与超声心动图指标及eGFR的相关性。结果持续性房颤组、阵发性房颤组和对照组患者的左房内径[(48.33±6.43) mm、(42.10±2.62) mm、(33.61±5.52) mm]、左心房容积指数[(35.79±3.66) mL/m、(31.28±4.11) mL/m、(26.10±3.02) m L/m]和NT-proBNP [(1 567.23±436.66) pg/mL、(908.62±199.57) pg/mL、(571.94±101.77) pg/mL]比较差异均有统计学意义(P<0.05),且三组间任意两组的上述指标比较差异均有统计学意义(P<0.05);而持续性房颤组、阵发性房颤组和对照组患者在左室舒张末内径、LVEF、E/Em方面比较差异均无统计学意义(P>0.05);Spearman相关性分析结果显示,NT-proBNP与左心房容积指数、左房内径呈正相关(r=0.470,0.626,P<0.05);与左室舒张末内径、LVEF、E/Em、eGFR无相关性(r=0.153,0.095,0.121,P>0.05)。结论非瓣膜性房颤并射血分数保留心衰患者的NT-proBNP水平显著提高,左房内径明显增大,且NT-proBNP与左心房容积指数、左房内径有明显的相关性。

Objective To analyze the correlation between echocardiographic parameters and N-terminal pro-brain natriuretic peptide(NT-proBNP) in patients with nonvalvular atrial fibrillation and ejection fraction preserved heart failure. Methods The clinical data of 100 patients with nonvalvular atrial fibrillation and heart failure with preserved ejection fraction treated in the Department of Cardiology, Jieyang People’s Hospital from June 2011 to June 2019 were retrospectively analyzed. The patients were divided into the paroxysmal atrial fibrillation group(43 cases) and persistent atrial fibrillation group(57 cases) according to the attack of atrial fibrillation. At the same time, 50 patients with diastolic dysfunction without atrial fibrillation were selected as the control group. The differences of left atrial diameter,left atrial volume index, mitral valve early diastolic peak velocity(E)/mitral annular early diastolic peak velocity(Em),left ventricular ejection fraction(LVEF), NT-proBNP and estimated glomerular filtration rate(eGFR) were analyzed, and the correlation between NT-proBNP and echocardiographic indexes and eGFR was analyzed by Spearman correlation analysis. Results There were significant differences in left atrial diameter with(48.33±6.43) mm,(42.10±2.62) mm,(33.61 ± 5.52) mm, left atrial volume index with(35.79 ± 3.66) mL/m,(31.28 ± 4.11) mL/m,(26.10 ± 3.02) mL/m, and NT-proBNP with(1567.23±436.66) pg/mL,(908.62±199.57) pg/mL,(571.94±101.77) pg/mL among persistent atrial fibrillation group, paroxysmal atrial fibrillation group, and control group(all P<0.05);there was no significant difference in left ventricular end diastolic diameter, LVEF and E/Em among persistent atrial fibrillation group, paroxysmal atrial fibrillation group and control group(all P>0.05). Spearman correlation analysis showed that NT-proBNP was positively correlated with left atrial volume index and left atrial diameter(r=0.470, 0.626, P<0.05), but not with left ventricular end diastolic diameter, LVEF, E/Em, e GFR(r=0.153, 0.095, 0.121, P>0.05). Conclusion NT-pro BNP level and left atrial diameter are significantly increased in patients with nonvalvular atrial fibrillation and ejection fraction preserved heart failure, and there is a significant correlation between NT-pro BNP and left atrial volume index and left atrial diameter.