肥厚型心肌病患者合并心房颤动的危险因素及预后分析

Risk factors and prognosis analysis of patients with hypertrophic cardiomyopathy complicating atrial fibrillation

目的探讨肥厚型心肌病(hypertrophic cardiomyopathy,HCM)合并心房颤动(简称房颤)患者的临床特征、危险因素及其预后。方法选取门诊或住院的HCM患者,根据是否合并房颤,将其分为房颤组和非房颤组。观察两组患者的临床特征和预后,并应用多因素Logistic回归分析探讨HCM患者合并房颤的危险因素。结果入选了144例HCM患者,其中房颤组32例(22.2%),非房颤组112例(77.8%)。多因素Logistic回归分析结果显示,左心房内径(left atrial diameter,LAD)增大(OR=64.301,P<0.01)和左心室射血分数(left ventricular ejection fraction,LVEF)降低(OR=29.922,P=0.025)是HCM患者合并房颤的独立危险因素。平均随访2年3个月,房颤组再入院率明显高于非房颤组(P<0.05);主要终点事件(死亡)与其他次要终点事件(心力衰竭和血栓栓塞等)发生率两组间的差异无统计学意义(P>0.05)。结论HCM患者合并房颤后的再入院治疗率显著上升,LAD增大和LVEF降低是HCM患者合并房颤的独立危险因素。

Objective To investigate the clinical characteristics,risk factors and prognosis of patients with hypertrophic cardiomyopathy(HCM)accompanied with atrial fibrillation(AF).Methods Outpatients or inpatients with HCM were selected,and divided into AF group and non-AF group based on the presence or absence of AF.The clinical features and prognosis of the two groups were observed.Multiple Logistic regression analysis was applied in exploring the risk factors of HCM patients complicating AF.Results A total of 144 HCM patients are enrolled in our study,with 32 patients(22.2%)in the AF group and 112 patients(77.8%)in the non-AF group.Multiple Logistic regression analysis reveals that enlarged left atrial diameter(LAD,OR=2.013,P=0.004)and reduced left ventricular ejection fraction(LVEF,OR=0.920,P<0.01)are independent risk factors for HCM patients with AF.During an average follow-up period of two years and three months,the readmission rate of patients in the AF group is significantly higher than that in the non-AF group(P<0.05);there is no significant difference in the primary endpoints(death)or other secondary endpoints(heart failure and thrombembolia)between the two groups(P>0.05).Conclusion The readmission rate of HCM patients complicated by AF is significantly increased.The enlarged LAD and reduced LVEF are independent risk factors for complicated AF among HCM patients.