肥厚型心肌病合并心房颤动患者的血栓栓塞风险临床研究  

Incidence of Thromboembolism and Cardiovascular Mortality in Hypertrophic Cardiomyopathy Patients Complicating With Atrial Fibrillation

作　　者：闫丽荣[1] 樊朝美[2] 安硕研 杭霏[2] 王莉[3] 张宇辉[2] 张健[2] YAN Li-rong;FAN Chao-mei;AN Shuo-yan;HANG Fei;WAN Li;ZHANG Yu-hui;ZHANG Jian(Department of Cardiology,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing (100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院心力衰竭中心,北京市100037 [3]中国医学科学院北京协和医学院国家心血管病中心阜外医院临床药理中心,北京市100037

出　　处：《中国循环杂志》2018年第12期1218-1222,共5页Chinese Circulation Journal

基　　金：中国医学科学院医学与健康科技创新工程项目(2016-I2M-1-006).

摘　　要：目的:分析中国人群肥厚型心肌病(HCM)合并心房颤动(房颤)患者的血栓栓塞风险和心血管死亡风险,并进一步验证欧洲研究提出的"肥厚型心肌病血栓栓塞风险预测模型(HCM Risk-CVA)"在中国人群的适用性。方法:连续纳入2005-01至2015-06期间在中国医学科学院阜外医院就诊的HCM合并房颤患者356例,回顾性分析其临床特点、血栓栓塞事件及心血管死亡事件。结果:331例(93.0%)患者完成随访。平均随访(5.0±2.6)年,271例(81.9%)患者未接受抗凝治疗,其中39例(14.4%)患者发生了血栓栓塞事件,血栓栓塞事件发生率为2.5%/年;60例(18.1%)患者接受了抗凝治疗,均无血栓栓塞事件发生,抗凝治疗患者的血栓栓塞事件发生率显著低于未接受抗凝治疗患者(P<0.01)。33例(10.0%)患者在随访期间发生了心血管死亡,心血管死亡率为1.9%/年。根据HCM Risk-CVA模型计算结果,将271例未接受抗凝治疗的患者分为血栓栓塞低-中危组(n=192)和血栓栓塞高危组(n=79);高危组血栓栓塞事件年发生率显著高于低-中危组(5.2%/年vs 1.6%/年,P<0.01)。HCM Risk-CVA模型评估血栓栓塞风险的受试者工作特征(ROC)曲线下面积为0.65(95%CI:0.54～0.76,P<0.01)。结论:HCM合并房颤患者的血栓栓塞事件发生率及心血管死亡率均较高。本研究人群中,HCM Risk-CVA模型可识别出血栓栓塞高危患者,对HCM合并房颤患者发生血栓栓塞风险有一定的预测价值。Objectives: This study was intended to investigate the incidence of thromboembolism and cardiovascular mortality in the largest Chinese cohort with hypertrophic cardiomyopathy(HCM) and atrial fibrillation and assessed the efficiency of the European 5-year risk prediction model of thromboembolism in hypertrophic cardiomyopathy(HCM Risk-CVA) in this population.Methods: A total of 356 consecutive patients admitted to our center from 2005 to 2015 with HCM and atrial fibrillation were enrolled in this retrospective study. Clinical characteristics and incidence of thromboembolism and cardiovascular mortality during the long-term outcomes were analyzed.Results: Follow-up data were available in 331 patients(93.0%). During the follow-up period of(5.0±2.6) years, 39 patients(14.4%) experienced thromboembolism events in the patients without anticoagulants, and the annual incidence of thromboembolism was 2.5%. In the 60 patients(18.1%) receiving regular anticoagulants treatment, none experienced thromboembolism(0.0%). Thirty patients died, and the annual mortality of HCM patients with atrial fibrillation was 1.9%. After dividing patients into different risk groups according to the HCM risk-CVA model, patients in the high-risk group were more likely to experience thromboembolism event than patients in the low-medium risk group(5.2%/y vs 1.6%/y,P<0.01). The HCM risk-CVA model fairly predicted thromboembolism with an area under the ROC curve of 0.65(95%CI: 0.54-0.76,P<0.01). Conclusions: Hypertrophic cardiomyopathy patients with atrial fibrillation have increased risk of thromboembolism and cardiovascular death. HCM risk-CVA model can be applied to distinguish high-risk patients of thromboembolism in Chinese HCM patients with atrial fibrillation.

关 键 词：心肌病 肥厚型 心房颤动 血栓栓塞 抗凝 

分 类 号：R54[医药卫生—心血管疾病]