老年重度瓣膜性心脏病合并心房颤动患者的危险因素分析

Analysis of risk factors for atrial fibrllation in elderly Chinese patients with severe valvular heart disease

目的探索中国老年重度瓣膜性心脏病(VHD)患者合并心房颤动(AF)的危险因素。方法横断面研究, 研究连续入选2021年9月至2022年3月在全国18家三甲医院诊断为老年重度VHD患者978例, 合并AF患者322例(32.9%)。收集临床资料和超声心动图数据, 分析合并AF的危险因素。结果在VHD患者中, 与非AF组比较, AF组患者年龄更大、女性比例更高、舒张压更高, 脑血管疾病, 慢性肾脏疾病比例更高, 血清中低密度脂蛋白胆固醇更低, 血肌酐、N末端脑钠肽前体(NT-pro-BNP)、糖化血红蛋白更高, 左房前后径更大, 左心室舒张末期内径、室间隔厚度、左心室后壁厚度更小(均P<0.05)。多因素Logistic回归分析显示, 左房前后径增大(OR=1.166、P<0.01)、左心室舒张末期内径减小(OR=0.929、P<0.01)、高龄(OR=1.051、P<0.05)是老年VHD合并AF的独立危险因素。结论老年重度VHD患者中, 高龄、左心房前后径增大、左心室舒张末期内径降低与AF独立相关。在老年重度的VHD患者应进行心脏结构评估及定期的随诊, 对疾病进行早期干预, 从而降低AF的发生率。

ObjectiveTo explore the risk factors for atrial fibrillation(AF)in elderly Chinese patients with severe valvular heart disease(VHD).MethodsThis was a cross-sectional study and consecutively enrolled 978 elderly patients with severe VHD diagnosed in 18 Class A tertiary hospitals across thecountry from September 2021to March 2022,including322(32.9%)patientswith concurrent AF.Clinical and echocardiographic data were collected to analyze the risk factors for AF.ResultsAmong VHD patients,compared with the non-AF group,the AF group was older,had a higher female ratio,higher diastolic blood pressure,higher proportions with cerebrovascular disease and chronic kidney disease,lower serum low density lipoprotein cholesterol and higher serum creatinine,amino-terminal A-type natriuretion peptide and glycosylated hemoglobin.As for echocardiographic parameters,the left atrial diameter was larger,the left ventricular end-diastolic diameter,interventricular septum thickness,and left ventricular posterior wall thickness were smaller in the AF group than in the non-AF group.All of the differences were statistically significant(all P<0.05).The results of multivariate Logistic regression analysis showed that the left atrial anteroposterior diameter increased(OR=1.166,P<0.01),the left ventricular end-diastolic diameter decreased(OR=0.929,P<0.01),and advanced age(OR=1.051,P<0.05)was an independent risk factor for elderly VHD patients with concurrent AF.ConclusionsIn elderly patients with severe VHD,advanced age,an increased left atrial anteroposterior diameter,and a decreased left ventricular end-diastolic diameter were independently associated with AF.Therefore,evaluation of cardiac structure and regular follow-up should be performed in elderly patients with severe VHD for early intervention to reduce the incidence of AF.