退行性二尖瓣关闭不全致室性心律失常的预测因素

Predictive factors of ventricular arrhythmia caused by degenerative mitral insufficiency

目的:探究退行性二尖瓣关闭不全导致室性心律失常发生的独立预测因素。方法:回顾性纳入2008-01-2017-12武汉亚洲心脏病医院心脏外科二尖瓣关闭不全患者204例,采集其基本资料、心脏超声、胸部正位片、心电图/动态心电图及相关实验室检查等参数。根据是否存在室性心律失常,将所纳入患者分为两组,采用二元Logistic回归分析评估致室性心律失常的独立预测因子。结果:与无室性心律失常组比较,室性心律失常组中-重度反流患者比例显著增高(76.99%∶91.21%,P=0.007),左房前后径(LAsA-P)显著增大[(4.796±0.531)cm∶(5.020±0.740)cm,P=0.017],ST-T改变患者比例更高(21.57%∶23.53%,P=0.049),心胸比值更高[(0.560±0.067)∶(0.580±0.074),P=0.045],肺淤血征象阳性患者比例更高(18.14%∶21.08%,P=0.035)。二元Logistic回归分析显示,中-重度二尖瓣反流为退行性二尖瓣关闭不全致室性心律失常的独立预测因子(OR:2.845,95%CI:1.186~6.823,P=0.019)。结论:中-重度二尖瓣反流是二尖瓣关闭不全患者出现室性心律失常的独立预测因子。

Objective:To explore independent predictors of ventricular arrhythmia caused by degenerative mitral insufficiency.Method:A total of 204 patients with mitral insufficiency in Wuhan Asian Heart Hospital from January 2008 to December 2017 were retrospectively enrolled.The basic data,cardiac ultrasound,chest radiograph,electrocardiogram/dynamic electrocardiogram and related laboratory examinations were collected.According to the presence or absence of ventricular arrhythmia,all patients were divided into two groups.The independent predictors of ventricular arrhythmia were evaluated by binary Logistic regression analysis.Result:Compared with nonventricular arrhythmia group,the proportion of moderate to severe regurgitation in ventricular arrhythmia group increased significantly(76.99%vs 91.21%,P=0.007),the LAsA-P increased significantly[(4.796±0.531)cm vs(5.020±0.740)cm,P=0.017],the proportion of ST-T change was higher(21.57%vs 23.53%,P=0.049),the ratio of heart to chest was higher(0.560±0.067 vs 0.580±0.074,P=0.049),and the proportion of pulmonary congestion was higher(18.14%vs 21.08%,P=0.035).Bivariate Logistic regression analysis showed that moderate to severe mitral regurgitation was an independent predictor of ventricular arrhythmia caused by degenerative mitral insufficiency(OR:2.845,95%CI:1.186-6.823,P=0.019).Conclusion:Moderate to severe mitral regurgitation is an independent predictor of ventricular arrhythmia in patients with degenerative mitral insufficiency.