心肌梗死后室壁瘤形成患者发生恶性室性心律失常的危险因素分析  

Risk factors analysis of malignant ventricular arrhythmias in patients with post infarction left ventricular aneurysm

作　　者：宁小晖[1] 杨子鹤 叶雪瑞 资艳花 王芳[1] 杨易剑 张晓丽[2] 张澍[1] Ning Xiaohui;Yang Zihe;Ye Xuerui;Zi Yanhua;Wang Fang;Yang Yijian;Zhang Xiaoli;Zhang Shu(Center of Arrhythmia,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China;Nuclear Medicine Department,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,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,心血管疾病国家重点实验室,阜外医院心律失常中心,100037 [2]首都医科大学附属北京安贞医院核医学科,100029

出　　处：《中华心律失常学杂志》2021年第3期239-243,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨心肌梗死后左心室室壁瘤形成患者发生恶性室性心律失常的临床特点以及相关危险因素。方法对2012年1月至2016年12月在中国医学科学院阜外医院诊断为心肌梗死后左心室室壁瘤形成的住院患者进行回顾性分析。依据恶性室性心律失常[持续性室性心动过速(室速)或心室颤动(室颤)/心室扑动]的发生情况分为室性心律失常组和非室性心律失常组。分析两组患者的临床资料,比较其合并的基础疾病、超声心动图指标、室壁瘤部位及大小等临床特点。应用单因素和多因素Logistic回归分析探讨患者恶性室性心律失常的相关危险因素。结果共纳入460例患者,其中有56例(12%,56/460)发生恶性室性心律失常(52例持续性室速,4例室颤)。室性心律失常组中有9例患者行植入型心律转复除颤器(ICD)治疗,1例行心脏再同步治疗除颤器(CRT-D)治疗,2例行导管消融术治疗,还有3例室颤患者在住院期间死亡。单因素Logistic回归分析显示男性、中重度二尖瓣反流、左心室舒张末期内径(LVEDD)、射血分数、心功能(NYHA分级)、急诊溶栓或经皮冠状动脉腔内血管成形术(PTCA)以及室壁瘤大小与恶性室性心律失常相关。纳入以上参数的多因素Logistic回归分析显示LVEDD(OR=2.05,95%CI 1.00~1.11)、中重度二尖瓣反流(OR=1.07,95%CI 0.98~4.38)以及室壁瘤大小(OR=1.00,95%CI 1.00~1.01)与恶性室性心律失常事件呈显著相关。结论心肌梗死后左心室室壁瘤形成患者具有较高的恶性室性心律失常发生率。LVEDD、室壁瘤的大小以及中重度二尖瓣反流是心肌梗死后左心室室壁瘤患者发生恶性室性心律失常的独立危险因素。Objective To investigate the clinical characteristics and risk factors of malignant ventricular arrhythmias in patients with post infarction left ventricular aneurysm(LVA).Methods Patients diagnosed as post infarction LVA in Fuwai Hospital were enrolled from January 2012 to December 2016.According to the presence of malignant ventricular arrhythmias(sustained ventricular tachycardia,ventricular fibrillation or ventricular flutter),patients were classified into 2 groups:ventricular arrhythmias group and no-ventricular arrhythmias group.The clinical characteristics,combined diseases and ultrasound parameters were recorded.Univariate and multivariate Logistic regressions were used to analyze the predictors of malignant ventricular arrhythmias in LVA patients.Results There were 460 patients enrolled and 56 patients(12%,56/460)with malignant ventricular arrhythmias(52 cases of sustained ventricular tachycardia,4 cases of ventricular fibrillation).Among them,9 patients received implantable cardioverter defibrillator(ICD)therapy,1 cadiac resyncronization therapy defibrillator(CRT-D)therapy,2 catheter ablation,and 3 patients with ventricular fibrillation died during hospitalization.Univariate Logistic regression analysis showed that male gender,moderate/severe mitral regurgitation(MR),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),cardiac function(classification of NYHA),thrombolysis/acute percutaneous transluminal coronary angioplasty(PTCA)and aneurysm diameter were associated with malignant ventricular arrhythmias.And multivariate Logistic regression analysis revealed that LVEDD(OR=2.05,95%CI 1.00-1.11),moderate/severe MR(OR=1.07,95%CI 0.98-4.38)and aneurysm diameter(OR=1.00,95%CI 1.00-1.01)were significantly correlated with presence of malignant ventricular arrhythmias.Conclusion The incidence of malignant ventricular arrhythmias in LVA patients were relatively higher.LVEDD,moderate/severe MR and the size of aneurysm were independent risk factors for malignant ventricular arrhy

关 键 词：心肌梗塞 室性心律失常 室壁瘤 

分 类 号：R542.22[医药卫生—心血管疾病] R541.7[医药卫生—内科学]