左心房大小对非梗阻性肥厚型心肌病患者心血管事件的预测  

Left atrial size predicts adverse cardiac events in patients with non-obstruction hypertrophic cardiomyopathy

作　　者：于扬[1] 盛琴慧[1] 张宝娓[1] 丁文惠[1] 

机构地区：[1]北京大学第一医院心内科,北京100034

出　　处：《北京大学学报（医学版）》2014年第2期207-210,共4页Journal of Peking University:Health Sciences

摘　　要：目的:探讨左心房大小对非梗阻性肥厚型心肌病(hypertrophic cardiomyopathy,HCM)患者心血管事件的预测价值。方法:符合入选标准的39例患者,随访(28.0±7.7)个月,根据患者是否发生心血管事件(心律失常、心绞痛、晕厥、充血性心力衰竭)分为对照组和事件组,对两组患者的临床资料及超声心动图参数进行统计学比较。应用受试者操作特征(receive operating characteristic,ROC)曲线评价左心房内径(left atrial diameter,LAD)、左心房容积指数(left atrial volume index,LAVI)对非梗阻性HCM患者心血管事件的预测价值。应用Kaplan-Meier法分析事件发生率。结果:随访期间39例患者中有11例(28.2%)发生心血管事件。事件组患者的LAD、左心房内径指数(left atrial diameter index,LADI)、左心房容积(left atrial volume,LAV)及LAVI均显著大于对照组(P<0.05)。LAD>4.29 cm对非梗阻性HCM患者预测心血管事件的灵敏度和特异度分别为63.6%和89.3%;LAVI>53.1mL/m2对非梗阻性HCM患者预测心血管事件的灵敏度和特异度分别为72.7%和71.4%。Kaplan-Meier分析同时显示,LAD>4.29 cm或LAVI>53.1 mL/m2的患者心血管事件发生率高(P<0.05)。结论:LAD、LAVI可以作为有效预测非梗阻性HCM患者心血管事件的指标。Objective：To evaluate the relationship between left atrial size and the risk of cardiac events in patients with non-obstruction hypertrophic cardiomyopathy. Methods：In the study, 39 patients who met inclusion criteria were followed up for （28.0 ± 7.7） months. The patients were divided into two groups with or without major adverse cardiac events （a composite of arrhythmia, angina, syncope and congestive heart failure）. Clinical and echocardiographic data of the two groups were compared. The predictive value of left atrial diameter （LAD） and left atrial volume index （LAVI） were reviewed by using receive operating characteristic curve （ROC）. The events analysis was performed by using the Kaplan-Meier analysis. Re- stilts：Cardiac events occurred in 11 patients （28.2%）. LAD, LAD index （LADI）, LAV and LAVI were significantly greater in the patients with cardiac events than those without cardiac events [ LAD ： （4.28 ± 0.63） cmvs. （3.85 ±0.48） cm, P=0.025; LADI： （0.048 9±0.011 1） cm/m^2vs. （0.040 8 ± 0.0058） em/mE, P=0.005; LAV： （60.8±16.2） mLvs. （46.2±14.0） mL, P=0.008; LAVI： （66.5± 23.8） mL/m^2 vs. （49.6 ± 15.9） rnL/m^2, P = 0. 014 ]. An LAD of 〉 4.29 cm identified patients with cardiac events with a sensitivity of 63.6% and a specificity of 89.3%. An LAVI of 〉53.1 mL/m^2 identified patients with cardiac events with a sensitivity of 72.7% and a specificity of 71.4%. The Kaplan-Meier analysis indica- ted that the patients with LAD 〉 4. 29 cm or LAVI 〉 53.1 mL/m^2 had higher incidence of cardiac events. Conclusion：LAD and LAVI may be effective markers for predicting adverse cardiac events in patients with non-obstruction hypertrophic cardiomyopathy.

关 键 词：心脏容量 心肌病 肥厚型 心血管疾病 灵敏度与特异度 生存分析 

分 类 号：R542.2[医药卫生—心血管疾病]