舒张期室壁应变评估的左心室顺应性与新发心房高频事件的相关性研究

Correlation between left ventricular compliance assessed by diastolic wall strain and new atrial high-rate episodes

目的探究由舒张期室壁应变(diastolic wall strain,DWS)评估的左心室顺应性与心脏植入式电子装置术后心房高频事件(atrial high-rate episodes,AHREs)的相关性。方法回顾性收集河北医科大学第一医院置入心脏植入式电子装置(cardiovascular implantable electric devices,CIEDs)的患者201例的病历资料。术后随访2年以上,根据是否发生AHREs分为AHREs组与无AHREs组。比较2组术前DWS及一般资料,并通过多因素COX逐步回归分析术后发生AHREs的独立危险因素。结果所有患者在置入术后12个月内出现AHREs 26例,总共有患者在术后2年内出现AHREs 64例。在随访期间对比AHREs组与无AHREs组,2组在左心房前后径、左心房横径、DWS因素有统计学意义(P<0.05)。多因素COX逐步回归分析示左心房横径增加与DWS降低是CIEDS术后患者发生AHREs的独立危险因素(P<0.05)。ROC曲线显示DWS最佳临界值为0.35,敏感度为81%,特异性为82%。与DWS≥0.35组相比,DWS<0.35组发生AHREs的风险增高(P<0.05)。结论DWS作为反应左心室舒张功能的超声心动图检测指标,该值降低增加了心脏植入式电子装置术后新发AHREs的风险。

Objective To explore the association of left ventricular compliance assessed by diastolic wall strain(DWS)with new atrial high-rate episodes(AHREs)after the implantation of cardiac implantable electronic devices(CIEDs).Methods The medical records of 201 patients with CIEDs implanted in the First Hospital of Hebei Medical University were collected retrospectively.The patients were followed up for more than 2 years.They were divided into AHREs group and non-AHREs group according to occurrence of AHREs.The preoperative DWS and general data of the two groups were compared,and the independent risk factors of AHREs after operation were analyzed by multivariate COX stepwise regression analysis.Results Of all patients,26 had AHREs within 12 months after implantation,and a total of 64 patients had AHREs within 2 years after implantation.During the follow-up period,the AHREs group and the non-AHREs group were compared,and there were significant differences in left atrial anteroposterior diameter,left atrial transverse diameter and DWS(P<0.05).Multivariate COX stepwise regression analysis showed that the increase of left atrial transverse diameter and the decrease of DWS were independent risk factors for AHREs in patients after CIEDS(P<0.05).ROC curve showed that the optimal critical value of DWS was 0.35,the sensitivity was 81%,and the specificity was 82%.Compared with the group with DWS≥0.35,the group with DWS<0.35 had an increased risk of AHREs(P<0.05).Conclusion As an echocardiographic marker reflecting left ventricular diastolic function,reduced DWS values increase the risk of new AHREs after CIEDS implantation.