A three-year longitudinal study of the relation between left atrial diameter remodeling and atrial fibrillation ablation outcome

Background The long-term prognostic influence of left atrial diameter （LAD） remodeling on the status of post-radiofrequency catheter ablation （RI CA） atrial fibrillation （AF） is unclear. This study employed a two-stage model from 3-year echocardiographic data to ascertain whether the two-stage model predicts RFCA outcome more favorably than models using the baseline LAD. Methods Data were retrospectively collected from 263 consecutive patients with drug-refractory AF undergoing RFCA. Regular echocardiographic measurements of LAD were performed at baseline, 1, 3, 6, and 12 months and then every 6 months after RFCA. Sex, age, type of AF, number of RFCA, and AF status were recorded. We obtain the actual （predicted） 3-year LAD using a longitudinal linear mixed model （1st stage）. Logistic regression models based on the baseline LAD （Model 1）, actual （predicted） 3-year LAD （Model 2） （2nd stage）, and observed 3-year LAD （Model 3） were constructed to predict RFCA outcome. The area under the receiver operating characteristic curve （AUC） were used to assess the performance of models. Results The lowess smoothed curve indicated that the LAD declined over the first three months and remained stable up to 36 months after RFCA. The degree of LAD reduction was significantly influenced by the baseline LAD. Non-paroxysmal AF, large LAD and female gender were significant predictors of AF recurrence. Model 2 had the largest AUC among the three models. Conclusions This longitudinal study-based two-stage model outperforms the original logistic model using the baseline LAD. Non-paroxysmal AF, larger LAD and female gender are significant predictors of RFCA failure.

Left atrial diameter and atrial fibrillation,but not elevated NT-proBNP,predict the development of pulmonary hypertension in patients with HFpEF

Background The determinants of pulmonary hypertension(PH)due to heart failure with preserved ejection fraction(HFpEF)have been poorly investigated in patients with cardiovascular diseases(CVD).Methods From July 12017 to March 312019,a total of 149 consecutive HFp EF patients hospitalized with CVD were enrolled in this prospective cross-sectional study.A systolic pulmonary artery pressure(PASP)>35 mm Hg estimated by echocardiography was defined as PH-HFp EF.Logistic regression was performed to establish predictors of PH in HFpEF patients.Results Overall,the mean age of participants was 72±11 years,and 74(49.7%)patients were females.A total of 59(39.6%)patients were diagnosed with PH-HFpEF by echocardiography.The left atrial diameter(LAD)was related to the ratio of the transmitral flow velocities/mitral annulus tissue velocities in early diastole(E/E’)and the left ventricular diameter in systole(LVDs).N-Terminal pro B-type natriuretic peptide(NT-proBNP)was not found to be associated with LAD and impaired diastolic or systolic function of the left ventricle.Multivariable logistic regression showed that atrial fibrillation(AF)increased the risk of PH-HFpEF incidence 3.46-fold with a 95%confidence interval(CI)of 1.44–8.32,P=0.005.Meanwhile,LAD≥45 mm resulted in a 3.43-fold increased risk,95%CI:1.51–7.75,P=0.003.However,the significance levels of NT-proBNP,age and LVEF were underpowered in the regression model.Two variables,AF and LAD≥45 mm,predicted the PH-HFpEF incidence(C-statistic=0.773,95%CI:0.695–0.852,P<0.001).Conclusions Two parameters associated with electrical and anatomical remodelling of the left atrium were related to the incidence of PH in HFpEF patients with CVD.

Prognostic value of the echocardiographic right/left ventricular end-diastolic diameter ratio in patients with idiopathic pulmonary arterial hypertension

Background Previous studies have shown that an echocardiographic right/left ventricular end-diastolic diameter ratio(RV/LV ratio)≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. The prognostic value of the RV/LV ratio in patients with idiopathic pulmonary arterial hypertension(IPAH) is still unknown. Methods We retrospectively enrolled 95 consecutive patients with newly diagnosed IPAH and 16 of them were reevaluated by echocardiography at 3-12 months following targeted therapy.Follow-up data were obtained by telephone interviews and review of the patients’ records.Results The RV/LV ratio was in parallel with the severity of World Health Orgnization(WHO) functional class and mean right atrial pressure.The RV/LV ratio was positively correlated with total pulmonary resistance(P P P 2 saturation(P P = 0.001),weight and absence of targeted therapy were independent predictors of death.No significant changes in the RV/LV ratio before and after targeted therapy were observed. A baseline RV/LV ratio≥0.84 or a further increase in the RV/LV ratio during targeted therapy indicated a poor prognosis. Conclusions The RV/LV ratio helps to assess the severity of IPAH and serves as an independent predictor of prognosis in patients with IPAH.

Left atrial enlargement and non-paroxysmal atrial fibrillation as risk factors for left atrial thrombus/spontaneous Echo contrast in patients with atrial fibrillation and low CHA2DS2-VASc score

Objective To determine the risk factors for thromboembolism in lower risk patients with non-valvular atrial fibrillation(AF)and low CHA2DS2-VASc scores,which remain undefined.Methods We retrospectively analyzed the baseline clinical characteristics,routine laboratory parameters,and echocardiographic measurements of 705 patients(71.1%male;mean age:52.10±9.64 years)with low CHA2DS2-VASc score(0 or 1;1 point for female sex)out of 1346 consecutive patients with non-valvular AF who underwent transesophageal echocardiography(TEE)at Guangdong Cardiovascular Institute between January 2013 and December 2015.Results Patients with left atrial thrombus(LAT)or spontaneous echo contrast(SEC)on TEE(24/705,4%)showed a higher incidence rate of vascular disease(54.2%vs.32.9%,P=0.045)and non-paroxysmal AF(79.2%vs.29.4%,P<0.001),larger left atrial diameter(43.08±4.59 vs.36.02±5.53 mm,P<0.001),and lower left ventricular ejection fraction(58.23±8.82%vs.64.15±7.14%,P<0.001)than those without.Multivariate logistic regression analysis identified left atrial diameter[odds ratio(OR)=1.171,95%confidence interval(CI):1.084–1.265,P<0.001]and non-paroxysmal AF(OR=3.766,95%CI:1.282–11.061,P=0.016)as independent risk factors for LAT/SEC.In ROC curve analysis,a left atrial dimeter cutoff of 37.5 mm yielded 95.0%sensitivity and 62.7%specificity(AUC:0.847,P<0.0001,95%CI:0.793–0.914).Conclusion In patients with non-valvular AF with low CHA2DS2-VASc score,the presence of LAT or SEC was associated with left atrial enlargement,which had moderate predictive value,and non-paroxysmal AF.

Value of Combining Left Atrial Diameter and Amino-terminal Pro-brain Natriuretic Peptide to the CHA2DS2-VASc Score for Predicting Stroke and Death in Patients with Sick Sinus Syndrome after Pacemaker Implantation

Background： The CHA2DS2-VASc score is used clinically for stroke risk stratification in patients with atrial fibrillation （AF）. We sought to investigate whether the CHA2DS2-VASc score predicts stroke and death in Chinese patients with sick sinus syndrome （SSS） after pacemaker implantation and to evaluate whether the predictive power of the CHA2DS2-VASc score could be improved by combining it with left atrial diameter （LAD） and amino-terminal pro-brain natriuretic peptide （NT-proBNP）. Methods： A total of 481 consecutive patients with SSS who underwent pacemaker implantation from January 2004 to December 2014 in our department were included. The CHA2DS2-VASc scores were retrospectively calculated according to the hospital medical records before pacemaker implantation. The outcome data （stroke and death） were collected by pacemaker follow-up visits and telephonic follow-up until December 3 l, 2015. Results： During 2151 person-years of follow-up, 46 patients （9.6%） suffered stroke and 52 （10.8%） died. The CHA2DS2-VASc score showed a significant association with the development of stroke （hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.20-1.75, P 〈 0.00 1） and death （HR 1.45, 95% CI 1.22-1.71, P 〈 0.001）. The combination of increased LAD and the CHA2DS2-VASc score improved the predictive power for stroke （C-stat 0.69, 95% CI 0.61-4）.77 vs. C-stat 0.66, 95% CI 0.57-0.74, P = 0.013）, and the combination of increased NT-proBNP and the CHA2DS2-VASc score improved the predictive power for death （C-stat 0.70, 95% CI 0.64-0.77 vs. C-stat 0.67, 95% CI 0.60--0.75, P= 0.023）. Conclusions： CHA2DS2-VASc score is valuable for predicting stroke and death risk in patients with SSS after pacemaker implantation. The addition of LAD and NT-proBNP to the CHA2DS2-VASc score improved its predictive power for stroke and death, respectively, in this patient cohort. Future prospective studies are warranted to validate the benefit of adding LAD and NT-proBNP to the CHA2DS2-VASc score for predicting stroke and death risk in non-AF populations.

Misdiagnosis of unroofed coronary sinus syndrome as an ostium primum atrial septal defect by echocardiography:A case report

BACKGROUND Unroofed coronary sinus syndrome(UCSS)is a rare congenital heart disease,which has variable morphologic features and is strongly associated with persistent left superior vena cava(PLSVC).However,it is often difficult to visualize the left-to-right shunt pathway through the CS by transthoracic echocardiography(TTE).CASE SUMMARY A 37-year-old female was admitted to the hepatological surgery department of a hospital with complaint of subxiphoid pain that had started 1 wk prior.Physical examination revealed a grade 3/6 systolic murmur at the left margin of the sternum,between the 2nd and 3rd intercostal cartilage.The patient underwent echocardiography and was diagnosed with ostium primum atrial septal defect(ASD);thus,she was subsequently transferred to the cardiovascular surgery department.A second TTE evaluation before surgery showed type IV UCSS with secundum ASD.Right-heart contrast echocardiography(RHCE)showed that the right atrium and right ventricle were immediately filled with microbubbles,but no microbubble was observed in the CS.Meanwhile,negative filling was observed at the right atrium orifice of the CS and right atrium side of the secundum atrial septal.RHCE identified UCSS combined with secundum ASD but without PLSVC in this patient.CONCLUSION This rare case of UCSS highlights the value of TTE combined with RHCE in confirming UCSS with ASD or PLSVC.

Clinical relevance of atrial septal aneurysm and patent foramen ovale with migraine

AIM To test the potential association between atrial septal aneurysm(ASA) and migraine in patent foramen ovale(PFO) closure patients through an observational, singlecenter, case-controlled study.METHODS We studied a total of 450 migraineurs who had rightto-left shunts and underwent PFO closure in a retrospective single-center non-randomized registry from February 2012 to October 2016 on the condition that they were aged 18-45 years old. Migraine was diagnosed according to the International Classification of Headache Disorders, 3^(rd) edition and evaluated using the Headache Impact Test-6(HIT-6). All patients underwent preoperative transesophageal echocardiography, contrast transthoracic echocardiography, and computed tomography or magnetic resonance imaging examinations, with subsequent fluoroscopy-guided PFO closure. Based on whether they have ASA or not, the patients were divided into two groups: A(PFO with ASA, n = 80) and B(PFO without ASA, n = 370). Baseline characteristics and procedural and follow-up data were reviewed. RESULTS Compared to group B, group A had an increased frequency of ischemic lesions(11.3% vs 6.2%, P = 0.038) and migraine with aura(32.5% vs 21.1%, P = 0.040). The PFO size was significantly larger in group A(P = 0.007). There was no significant difference in HIT-6 scores between the two groups before and at the oneyear follow-up after the PFO closure [61(9) vs 63(9), P = 0.227; 36(13) vs 36(10), P = 0.706].CONCLUSION Despite its small sample size, our study suggests that the prevalence of ASA in PFO with migraine patients is associated with ischemic stroke, larger PFO size, and migraine with aura.

Hypoxemia without persistent right-to-left pressure gradient across a patent foramen ovale:A clinical challenge

Patent foramen ovale (PFO) closure for systemic hypoxemia is controversial. The first systematic, albeit retrospective, study was recently presented which showed good procedural and clinical success for PFO closure for this indication. We present a case of acute right to left intra-cardiac shunt across PFO where the shunting is not persistent. Hence making a decision on PFO closure based on the aforementioned promising trial may not have been the right decision for the patient. This case highlights that the decision on PFO closure for such indication needs to be individualized. We also review the sparse literature on PFO closure for this indication and discuss how the decision making for such indication needs to be individualized.

Detection of ST-2 and TGF-β2 levels in patients with atrial fibrillation and their correlation with atrial fibrillation remodeling

Objective:To observe the changes of serum soluble ST-2(suppressive tumorigenicity-2,sST2)and serum transforming growth factor-β2(TGF-β2)levels in patients with atrial fibrillation,and analyze the two with known left atrium The correlation of left atrial diameter(LAD),to explore its relationship with the development of atrial fibrillation.Methods:126 patients with atrial fibrillation(AF)who were treated in the Department of Cardiology of the First Affiliated Hospital of Bengbu Medical College from December 2019 to July 2020 were selected,including 69 males and 57 females,aged 62-74 years,average(64.38±5.31)years old,patients with atrial fibrillation were divided into three groups according to the relevant guidelines,namely,paroxysmal AF group(Paroxysmal AF group)45 cases,persistent atrial fibrillation AF group(Persistent AF group)42 cases,permanent 39 cases in the Permanent AF group.64 healthy sinus rhythms(SR)were selected as the healthy control group during the same period of physical examination,including 34 males and 30 females,aged 60-75 years,average(65.25±4.37)years,using enzyme-linked adsorption Immunoassay(ELISA)was used to determine the levels of ST-2 and TGF-β2 in the serum,and to analyze the correlation with the measured LAD.Results:Compared with the control group,the ST-2 level in the experimental group was significantly higher,and the serum ST-2 level:permanent atrial fibrillation group>persistent atrial fibrillation group>paroxysmal atrial fibrillation group.Compared with the control group,the TGF-β2 level in the experimental group was significantly higher,and the serum TGF-β2 level:permanent atrial fibrillation group>persistent atrial fibrillation group>paroxysmal atrial fibrillation group.The correlation analysis between ST-2,TGF-β2 and LAD was carried out.Correlation analysis showed that the concentration of ST-2 was significantly positively correlated with the size of LAD in all experimental groups(γ=0.784,P<0.001).Correlation analysis showed that there was a significant positive correlation between TGF-β2 and LAD in all experimental groups(γ=0.815,P<0.001).Correlation analysis showed that there was a significant positive correlation between ST-2 and TGF-β2 concentrations in all experimental groups(γ=0.777,P<0.001).Conclusion:ST-2 and TGF-β2 are closely related in the development of atrial fibrillation,and can be used as new indicators to predict the prognosis of atrial fibrillation and provide new ideas and references for the diagnosis and treatment of atrial fibrillation.ST-2 and TGF-β2 are correlated with the development of atrial fibrillation.High levels of ST-2 and TGF-β2 may indicate poor prognosis and treatment effects in patients with atrial fibrillation.

CT肺动脉造影推导的右心室与左心室直径比对急性肺栓塞危险分层及预后的评估价值

目的分析计算机断层扫描肺动脉造影(CTPA)推导的右心室(RV)与左心室(LV)直径比,对急性肺栓塞(APE)危险分层及预后的预测效能。方法回顾性分析2019-03至2023-04在武警贵州总队医院接受利伐他班预防急性静脉血栓的211例APE患者的电子医疗记录。根据简化版肺栓塞严重指数(sPESI)、肌钙蛋白检测、超声心动图检查将患者分为低危(n=69)、中低危(n=74)、中高危(n=68)。通过超声心动图评估RV收缩功能障碍(RVD),由影像科专家在CTPA图像上垂直于心脏长轴的单次横向扫描中测量RV和LV直径。随访90 d内的不良复合事件发生情况。结果不良结局APE患者的RV/LV更高(P<0.05),RV/LV预测APE患者短期预后的受试者工作特征曲线下面积(ROCAUC)结果为0.784,在最佳截断值(1.02)处,灵敏度79.9%,特异度75.3%。多元Logistics回归分析结果显示,RV/LV直径比>1.02为APE患者短期预后不良结局的独立危险因素。中高危患者的RV/LV直径比(1.11±0.25)高于低危(0.96±0.18)及中低危(0.99±0.28)患者(F=7.431,P=0.001)。RV/LV直径比预测中高危APE的ROCAUC为0.780。在RV/LV直径比≤1.02的70例患者中,14例(20.0%)通过超声心动图检测到RVD;在>1.02的134例患者中,77例(57.46%)通过超声心动图检测到RVD。Spearman秩相关分析结果显示,RV/LV直径比与sPESI(r_(s)=0.289)、肌酸激酶同工酶(r_(s)=0.291)、D-二聚体(r_(s)=0.386)呈正相关。结论根据CTPA推导的RV/LV直径比有助于评估APE患者的危险分层和短期不良预后。

左心房容积指数与左心房前后径评价左心室舒张功能的一致性

目的探讨左心房容积指数(LAVI)与左心房前后径(LAAP)的关系以及二者评价左心室舒张功能的一致性。方法选取我院2018年7月至2019年12月进行超声心动图检查患者315例,其中健康者68例(21.6%),高血压患者98例(31.1%),冠状动脉粥样硬化性心脏病患者97例(30.8%),扩张型心肌病患者32例(10.2%),肺源性心脏病患者11例(3.5%),先天性心脏病患者9例(2.9%)。收集患者临床一般资料,超声心动图检测患者各项心脏指标,包括LAAP、左心房容积(LAV)、二尖瓣舒张早期峰值血流速度(MV E)、二尖瓣舒张晚期峰值血流速度(MV A)、二尖瓣环室间隔部位舒张早期峰值速度(Septal e’)、二尖瓣环侧壁部位舒张早期峰值速度(Lateral e’)、三尖瓣反流峰速(TR)、左心室射血分数(LVEF)等。根据LVEF分为LVEF正常组(LVEF≥53%,n=264)和LVEF减低组(LVEF<53%,n=51),采用独立样本t检验比较2组左心室舒张功能指标的差异。采用Pearson或Spearman相关分析LAVI与LAAP的相关性;采用Kappa检验分析LAAP和LAVI评价左心室舒张功能的一致性。结果与LVEF正常组比较,LVEF减低组患者LAAP、LAV、LAVI、E/e’及TR显著增大(均P<0.001),而Septal e’及Lateral e’显著减小(均P<0.001)。LAAP和LAVI水平呈正相关(r=0.74,P<0.001)。LAAP和LAVI评价左心室舒张功能是否减低及分级的一致性均较强(均P<0.001)。结论LAAP与LAVI水平呈正相关;LAAP与LAVI评价左心室舒张功能是否减低和分级时一致性均较强。LVEF减低时,LAAP与LAVI相关性更高,LAAP与LAVI评价左心室舒张功能分级的一致性更强。因此,对于LVEF减低患者,当无法获得LAVI指标时,可用LAAP替代LAVI进行评估。

心房颤动患者血清脂蛋白a、Apelin-13、转化生长因子β1水平与左心房内径的关系

目的 探讨心房颤动(AF)患者血清脂蛋白a[Lp(a)]、Apelin-13、转化生长因子β1(TGF-β1)及左心房内径(LAD)间的关系。方法 2022年12月至2024年1月,选择在滁州市第一人民医院心内科住院患者100例,按照是否发生AF分为2组,AF组50例,非AF(NAF)组50例。检测2组患者血清Lp(a)、Apelin-13、TGF-β1水平,采用经胸超声心动图检查左心房内径并进行相关性分析。结果 AF组Lp(a)、TGF-β1水平及LAD升高,Apelin-13水平降低,与NAF组比较差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,Lp(a)、TGF-β1、舒张压及LAD为AF的危险因素,Apelin-13为AF的保护因素(P<0.05),且Lp(a)、TGF-β1、LAD及Apelin-13对AF具有预测价值(P<0.05)。线性回归结果显示,Lp(a)、TGF-β1、Apelin-13对LAD的回归系数分别为0.01(P>0.05)、-0.04(P>0.05)、-1.22(P<0.05)。结论 Lp(a)、TGF-β1及LAD为AF的独立危险因素;但Lp(a)、TGF-β1与LAD无明确相关性;Apelin-13作为AF独立保护因素,与LAD呈负相关。

不同心房颤动类型患者合并缺血性卒中的危险因素分析

目的探讨不同心房颤动(房颤)类型患者合并缺血性卒中的危险因素。方法连续入选2016年1月至2021年4月于中国中医科学院广安门医院心内科住院的非瓣膜性房颤患者751例,分为阵发性房颤(367例)和持续性房颤(384例),将不同房颤类型患者分为缺血性卒中组和非缺血性卒中组,分析不同类型房颤合并缺血性卒中的危险因素。结果在房颤合并卒中患者中,持续性房颤患者比例大于阵发性房颤(P<0.05),在阵发性房颤患者中,卒中组合并高血压、冠心病、心力衰竭(心衰)、糖尿病比例高于无卒中组,CHA2DS2-VASc评分高于无卒中组[(5.92±1.41)分比(3.97±1.26)分,P<0.05]。多因素logistics回归分析显示,冠心病(OR=3.795,95%CI 1.011~14.241,P<0.05)、糖尿病(OR=2.121,95%CI 1.272~3.536,P<0.05)是阵发性房颤合并缺血性卒中的独立危险因素。持续性房颤患者中,卒中组女性(P<0.05)、合并高血压(P=0.012)比例高于无卒中组,年龄[(79.34±6.62)岁比(74.5±9.70)岁]、左心房内径(LAD)[(49.28±4.29)mm比(42.13±3.96)mm]、CHA2DS2-VASc评分[(3.97±1.38)分比(3.61±1.37)分]高于无卒中组(P<0.05),接受抗凝治疗患者比例低于无卒中组(P<0.05),多因素logistics回归分析显示,年龄(OR=1.062,95%CI 1.025~1.100,P<0.05)、女性(OR=2.917,95%CI 1.681~5.060,P<0.05)、LAD(OR=1.165,95%CI 1.105~1.230,P<0.05)是持续性房颤合并缺血性卒中的独立危险因素,接受抗凝治疗(OR=0.332,95%CI 0.194~0.566,P<0.05)是保护因素。结论冠心病、糖尿病是阵发性房颤患者合并缺血性卒中的独立危险因素,持续性房颤患者的年龄、女性、LAD、抗凝情况与缺血性卒中密切相关,抗凝治疗。因此,对于阵发性房颤制定相应的预防策略,或积极进行节律控制、抗凝治疗,以降低缺血性卒中风险。

心源性缺血性脑卒中的临床特征及危险因素分析

目的:分析心源性缺血性脑卒中的临床特征及危险因素。方法:选取广安市人民医院2019年11月—2022年11月收治的210例缺血性脑卒中病人。根据急性脑卒中Org10172试验(TOAST)分型将病人分为心源性脑卒中(42例)、大动脉粥样硬化性脑卒中(73例)、腔隙性脑卒中(66例)、不明原因脑卒中(29例),比较不同TOAST分型脑卒中病人超声心动图参数,分析心源性缺血性脑卒中影响因素,评价超声心动图参数联合D-二聚体对心源性缺血性脑卒中的诊断价值。结果:心源性缺血性脑卒中病人左心房内径(LAD)大于其他TOAST分型脑卒中病人,左室射血分数(LVEF)及每搏输出量(SV)均小于其他TOAST分型脑卒中病人,D-二聚体及N末端B型脑钠肽前体水平均高于其他TOAST分型脑卒中病人,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,D-二聚体、LAD及SV均是心源性缺血性脑卒中的影响因素(P<0.05);受试者工作特征(ROC)曲线显示,D-二聚体、LAD、SV诊断心源性缺血性脑卒中的曲线下面积(AUC)分别为0.737,0.751,0.711,截断值分别为291.32 ng/mL、37.57 mm、70.16 mL,三者联合诊断的AUC为0.853,敏感度、特异度分别为73.81%、91.07%。结论:心源性缺血性脑卒中病人LAD增大,LVEF及SV均降低;D-二聚体、LAD及SV均是心源性缺血性脑卒中的危险因素;LAD、SV联合D-二聚体对心源性缺血性脑卒中有一定诊断价值,可辅助心源性缺血性脑卒中病人的快速筛选。

对比增强经颅多普勒评估房间隔膨出瘤患者右向左分流

目的探讨对比增强经颅多普勒对房间隔膨出瘤患者心脏水平右向左分流的评估及临床意义。资料与方法回顾性收集2020年6月—2021年7月焦作市人民医院40例房间隔膨出瘤患者和同期242例非膨出瘤患者,均行对比增强经颅多普勒(发泡试验)检查,比较在静息状态下和Valsalva动作后两组右向左分流的总体阳性率;并按监测到的微气泡数量将两组右向左分流进一步分为小量分流和大量分流,比较两组小量分流和大量分流的发生比例,以及Valsalva动作后两组分流量的变化。结果静息状态对比增强多普勒:膨出瘤组右向左分流阳性率高于非膨出瘤组[47.5%(19/40)比29.8%(72/242);χ^(2)=4.95,P=0.03];膨出瘤组小量分流14例(73.7%),大量分流5例(26.3%);非膨出瘤组小量分流61例(84.7%),大量分流11例(15.3%)。静息状态下,两组均以小量分流居多,两组小量和大量的比例差异无统计学意义(χ^(2)=1.26,P=0.264)。Valsalva动作对比增强多普勒:Valsalva动作后两组总体阳性率较静息状态下均显著提高(膨出瘤组77.5%,χ^(2)=8.64,P=0.002;非膨出瘤组48.8%,χ^(2)=80.49,P<0.001);其中大量分流病例数显著增加,膨出瘤组大量分流发生率为64.5%(20/31),非膨出瘤组大量分流发生率为47.5%(56/118),膨出瘤组显著高于非膨出瘤组(χ^(2)=12.58,P<0.001)。结论房间隔膨出瘤患者常伴右向左分流,尤其是Valsalva动作后,对于此类患者,临床上应给予足够的重视,进行规范诊断和治疗。

心房颤动患者左心房内径与肾功能的相关性研究

目的 探讨心房颤动患者左心房内径(LAD)与肾功能的相关性。方法 选取364例心房颤动患者作为研究对象,收集患者的临床资料,包括性别、年龄、身高、体质量、吸烟史、饮酒史、心房颤动类型、高血压病史、冠心病病史、糖尿病病史、心力衰竭病史、用药史、高敏肌钙蛋白I、脑钠肽、C反应蛋白、肌酐、尿素氮、LAD、左室射血分数(LVEF)、左室舒张末期内径(LVDd)、左室后壁厚度(LVPWTd)和室间隔厚度(IVSTd);计算估算肾小球滤过率(eGFR)和体质量指数。采用Spearman相关分析法探讨LAD与肌酐、尿素氮、eGFR的相关性;将eGFR<60 mL/(min·1.73 m^(2))设定为肾功能不全,采用单因素Logistic回归分析探讨心房颤动患者肾功能不全的影响因素;采用二元Logistic回归分析探讨房颤患者LAD与肾功能不全的关系。结果 Spearman相关分析结果显示,心房颤动患者中LAD与肌酐(r=0.279,P<0.001)、尿素氮(r=0.190,P<0.001)呈正相关,与eGFR(r=-0.263,P<0.001)呈负相关。单因素Logistic回归分析结果显示,性别、糖尿病病史、高血压病史、冠心病病史、心力衰竭病史、房颤类型、钠-葡萄糖共转运蛋白2抑制剂用药史、利尿剂用药史、LAD、LVEF、LVDd、IVSTd均为房颤患者肾功能不全的影响因素(P<0.05)。二元Logistic回归分析结果显示,与LAD第1四分位(LAD≤38 mm)相比,LAD第4四分位(LAD>47 mm)心房颤动患者发生肾功能不全的风险升高5.199倍(OR=5.199, 95%CI:1.210~22.337,P=0.027)。结论 心房颤动患者的LAD与肾功能显著相关,且LAD是心房颤动患者肾功能不全的影响因素。

经皮封堵术治疗复杂型卵圆孔未闭的疗效分析

目的:分析长隧道型或合并房间隔膨出瘤(atrial septal aneurysm,ASA)的卵圆孔未闭(patent foramen oval,PFO)经皮封堵术后的临床疗效及相关影响因素。方法:选取2021年3月至2022年8月期间,于郑州市第七人民医院行PFO封堵术的24例长隧道型或合并ASA的PFO患者。在术前、术后3个月、术后6个月对患者进行随访观察,记录患者偏头痛、头晕等临床症状的程度及持续时间,以头痛影响测定评分-6(headache impact test-6,HIT-6)和头晕视觉模拟量表(visual analogue scale,VAS)表示。结果:术后随访,此类PFO患者术后3个月临床症状缓解有效的18例(75.0%),术后6个月临床症状缓解有效的20例(83.3%),封堵术前术后HIT-6评分及头晕VAS评分均显著降低(P<0.01)。6例术前有脑血管事件发生的患者,术后6个月均无再发脑血管事件。结论:长隧道型或合并ASA的PFO患者,行PFO封堵术可以有效缓解相关临床症状,改善生命质量,同时手术安全性较高,具有一定临床指导意义。

左束支区域起搏对房室传导阻滞患者术后新发房性心律失常的影响

目的探讨左束支区域起搏(left bundle branch area pacing,LBBaP)对房室传导阻滞(AVB)患者术后新发心房颤动(new-onset atrial fibrillation,NOAF)和心房高频事件(atrial high rate episodes,AHREs)的影响。方法回顾性纳入84例行起搏治疗的三度房室传导阻滞(ⅢAVB)患者,根据心室电极位置分为LBBaP组(n=42)和右室间隔部起搏(RVSP)组(n=42)。比较两组患者术前术后QRS波时限(QRSd)、心室起搏参数,并发症、脑卒中事件和NOAF、AHREs发生率。结果(1)LBBaP组术后NOAF、AHREs发生率均低于RVSP组(P<0.05)。(2)LBBaP组的p-QRSd短于RVSP组(P<0.05)。(3)两组患者心室起搏参数、并发症及脑卒中事件发生率之间差异无统计学意义(P>0.05)。结论相对于右室起搏,LBBaP术后AHREs、NOAF的发生率较低,可改善患者预后。

阵发性心房颤动进展为持续性心房颤动的危险因素分析

目的探讨阵发性心房颤动进展为持续性心房颤动的危险因素。方法连续选择2016年1月至2021年10月期间于广安门医院心内科病房收治的确诊为非瓣膜性心房颤动患者782例,分为持续性心房颤动组(n=399)和阵发性心房颤动组(n=383),使用Logistic回归评估持续性心房颤动的危险因素。结果持续性心房颤动组年龄(P<0.001)、左心房内径(LA,P<0.001)大于阵发性心房颤动患者,合并冠心病(P<0.001)、心力衰竭(P<0.05)、缺血性卒中(P<0.01)、糖尿病(P<0.05)、高尿酸血症(P<0.001)、慢性肾功能不全(P<0.001)等疾病的比例较阵发性心房颤动患者高。Logistic回归分析提示LA≥40 mm(OR=6.40,95%CI:4.35~9.40,P<0.001)、合并冠心病(OR=1.56,95%CI:1.09~2.22,P<0.05)是持续性心房颤动的独立危险因素。结论冠心病和左房内径增大是阵发性心房颤动进展为持续性心房颤动的独立危险因素。

心房颤动介入术后医源性房间隔缺损右向左分流发生情况及其临床影响的研究

目的探讨心房颤动(房颤)患者介入治疗中行房间隔穿刺术后造成医源性房间隔缺损(iASD)的右向左分流(RLS)发生情况及影响因素,并分析其与新发偏头痛之间的相关性,为相关临床事件的预防和治疗提供依据。方法选取2022年11月至2023年3月阜阳市人民医院心血管内科收治的行房颤介入手术[包括导管射频消融术(RFCA)、经皮左心耳封堵术(LAAC)、“一站式”(RFCA+LAAC)手术]的患者54例,根据术后48 h内iASD是否存在RLS分为RLS组24例与非RLS组30例,收集2组一般临床资料及超声指标,分析RLS的发生情况和影响因素,以及术后3个月内新发偏头痛情况。结果所有患者术后iASD均出现左向右分流,24例(44.44%)患者出现RLS,iASD为(5.12±0.80)mm。随访3个月,2组新发偏头痛比较,差异无统计学意义(P>0.05)。RLS组年龄、持续性房颤比例、iASD尺寸大于非RLS组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,iASD尺寸是发生RLS的危险因素(OR=2.245,95%CI:1.040~4.846,P=0.040)。结论房颤介入治疗术后iASD出现RLS较为常见,与患者早期出现新发偏头痛无相关性,iASD尺寸是发生RLS的危险因素。同时,iASD在血流动力学及临床事件方面的影响应予以关注。