非瓣膜性心房颤动合并慢性心力衰竭患者经皮左心耳封堵术安全性及有效性分析

Safety and efficacy of percutaneous left atrial appendage closure in patients with nonvalvular atrial fibrillation and chronic HF

目的探讨左心耳封堵术(LAAC)在非瓣膜性心房颤动(NVAF)合并慢性心力衰竭(CHF)患者中的安全性及有效性。方法回顾性分析2019年7月至2021年7月江苏省苏北人民医院心血管内科接受LAAC治疗的NVAF患者58例,根据是否合并CHF将其分为合并CHF组23例和未合并CHF组35例。另选取同期接受口服抗凝药物(OAC)预防栓塞的NVAF合并CHF患者60例作为对照组(OAC组)。收集3组患者年龄,性别,心功能,栓塞及出血评分,既往慢性疾病等基线资料,记录合并CHF组与未合并CHF组左心耳特征及围术期不良事件,通过门诊及电话随访,记录1年内血栓栓塞、脑卒中、出血事件、生存情况、再入院情况。结果合并CHF组年龄、N末端B型钠尿肽前体、左心房内径、CHA_(2)DS_(2)-VASc评分明显高于未合并CHF组,LVEF明显低于未合并CHF组,CHA_(2)DS_(2)-VASc评分、出血风险评估(HAS-BLED)评分明显高于OAC组,差异有统计学意义(P<0.05,P<0.01)。封堵器置入成功率100%;合并CHF组与未合并CHF组围术期严重出血、脑卒中、心包填塞等严重不良事件发生率比较,差异无统计学意义(P>0.05)。随访1年,3组脑卒中事件、严重出血发生率以及死亡情况比较,差异无统计学意义(P>0.05);与OAC组比较,合并CHF组主要不良心血管事件发生率明显降低[4(17.4%)vs 26(43.3%),P=0.024]。结论LAAC对于CHF合并心房颤动患者,是一种安全有效的预防脑卒中方法,与OAC比较,有助于降低短期内不良心血管事件风险。

Objective To investigate the safety and effectiveness of left atrial appendage closure(LAAC)in patients with nonvalvular atrial fibrillation(NVAF)combined with chronic heart failure(CHF).Methods Fifty-eight NVAF patients treated with LAAC admitted to Department of Cardiovascular Medicine of Northern Jiangsu People's Hospital from July 2019 to July 2021 were recruited and divided into combined CHF group(23 cases)and the uncomplicated CHF group(35 cases)according to whether they accompanied with CHF.In addition,60 NVAF patients with CHF who received oral anticoagulants to prevent embolism at the same period were selected as the control group(the OAC group).Baseline data such as age,sex,cardiac function,embolic and bleeding scores,and previous chronic comorbidities were collected from the three groups.Characteristics of left atrial appendage and perioperative adverse events were recorded for both the combined CHF group and the uncomplicated CHF group of left atrial closure.The incidences of thromboembolism,stroke and bleeding events,survival outcome,and readmission were recorded during one year of follow-up through outpatient visit and telephone.Results The combined CHF group were significantly older and had higher NT-proBNP,larger LAD and increased CHA_(2)DS_(2)-VASc but lower LVEF than the uncomplicated CHF group,and had higher CHA_(2)DS_(2)-VASc score and HAS-BLED score than the OAC group(P<0.05,P<0.01).LAAC was successfully performed on the patients of the combined CHF group and the uncomplicated CHF group.There were no statistical differences in the incidences of perioperative adverse events such as serious bleeding,stroke and pericardial tamponade between the two groups(P>0.05).In 1 year follow-up,no significant differences were observed in the incidences of stroke and severe bleeding and survival outcome in the three groups(P>0.05).The incidence of MACE was notably lower in the combined CHF group than the OAC group[4(17.4%)vs 26(43.3%),P=0.024].Conclusion LAAC is a safe and effective procedure for stroke prevention in NVAF patients with CHF.And,it is superior to oral anticoagulation to reduce the risk of short-term adverse cardiovascular events.