左心房/肺静脉重构在孤立性心房颤动进展中的作用  

Left atrial/pulmonary veins remodeling in the progression of lone atrial fibrillation

作　　者：徐霞[1] 刘兴鹏[1] 董建增[1] 喻荣辉[1] 汤日波[1] 龙德勇[1] 刘小慧[1] 马长生[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科房颤中心,100029

出　　处：《中华心律失常学杂志》2010年第5期383-387,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的 探讨孤立性心房颤动（房颤）进展过程中左心房/肺静脉重构的作用.方法 连续47例孤立性房颤患者在房颤心律下接受左心房/肺静脉CT检查,其中25例为阵发性房颤,22例为新发持续性房颤.通过对两组间有差异的CT指标进行Logistic回归分析,确定孤立性房颤进展的预测指标.结果 新发持续性房颤组的平均房颤持续时间为1～12（6.4±4.3）周.与阵发性房颤组比较,新发持续性房颤组呈现如下的左心房/肺静脉重构特征：（1）左心房非对称扩张;（2）左心房容积显著增大;（3）肺静脉开口扩张.经Logistic回归分析,左心房容积（P=0.003,OR=1.139,95%可信区间：1.046～1.240）是预测孤立性房颤进展最强的独立指标.左心房容积≥108 ml预测孤立性房颤由阵发性进展为持续性的敏感性为68.2%,特异性为88%.结论 孤立性房颤在由阵发性进展为持续性的过程中伴随有显著的左心房和肺静脉重构;左心房容积显著增加是该过程的独立预测指标.Objective To investigate the left atrial（LA）and pulmonary veins（PVs）remodeling in the progression of lone atrial fibrillation （AF）. Methods We prospectively enrolled 47 consecutive patients with lone AF,in whom dual-source 64 slices computed tomography（CT） scanning of LA/PVs was conducted under AF rhythm. Of them ,25 were compatible the definition of paroxysmal AF and another 22 had a preceding history of paroxysmal AF and the duration of continuous AF was less than 3 months （ recently developed persistent AF）. The independent CT parameters predicting lone AF progression were determined by Logistic multivariate regression. Results The mean duration of continuous AF in patients with recently developed persistent AF was 1 ～ 12 （6.4 ± 4.3 ）weeks. Compared with the patients with paroxysmal AF, patients with recently developed persistent AF showed： （ 1 ） asymmetric LA enlargement; （ 2 ） dramatic increase in the LA volume; and （3） PV ostium dilation. Logistic regression analysis revealed that LA volume（ odds ratio, 1. 139 ;95% confidence interval, 1. 046 to 1. 240; P = 0. 003 ） was the strongest independent predictor of lone AF progression. The sensitivity and the specificity of LA volume 〉 108 ml in predicting lone AF progression were 68.2% and 88% ,respectively. Conclusion Progression to persistent AF is characterized by prominent LA/PV morphological remodeling in patients with lone AF. A dramatic increase in LA volume is the only factor associated with this process.

关 键 词：心房颤动 左心房 肺静脉 计算机断层显像 重构 

分 类 号：R541.75[医药卫生—心血管疾病]