心房颤动合并功能性二尖瓣反流的危险因素分析及导管消融的影响  

Risk factors of atrial fibrillation complicated with functional mitral regurgitation and the effect of catheter ablation

作　　者：赵丹清 张付涛 刘晓洁 吴金涛 张雷明[2] 胡娟[2] 范宪伟[2] 杨海涛[2] 严丽洁[2] 刘静静[2] 王山岭[2] ZHAO Danqing;ZHANG Futao;LIU Xiaojie;WU Jintao;ZHANG Leiming;HU Juan;FAN Xianwei;YANG Haitao;YAN Lijie;LIU Jingjing;WANG Shanling(Department of Cardiology,Henan University People’s Hospital,Henan Provincial People’s Hospital,Zhengzhou,450003,China;Heart Centre of Henan Provincial People’s Hospital,Central China Fuwai Hospital of Zhengzhou University)

机构地区：[1]河南大学人民医院河南省人民医院心内科,郑州450003 [2]河南省人民医院心脏中心郑州大学华中阜外医院

出　　处：《临床心血管病杂志》2022年第5期368-372,共5页Journal of Clinical Cardiology

基　　金：河南省医学科技攻关计划省部共建项目(No:SBGJ202002030);河南省科技攻关项目(No:212102310793)。

摘　　要：目的:探讨心房颤动(AF)患者合并中、重度功能性二尖瓣反流(FMR)的危险因素以及AF导管消融对FMR的影响。方法:从2018年1月—2019年12月到我院心律失常科就诊的首次行AF导管消融的患者中,连续入选合并中、重度FMR的患者88例,无或轻度FMR患者277例。比较两组基线资料,应用logistic回归分析评价AF合并中、重度FMR的危险因素。依据AF合并中、重度FMR患者术后是否发生AF复发分为维持窦律组与AF复发组,比较两组术前、术后随访心脏彩超结果。结果:多因素logistic回归分析显示:年龄(OR=1.07;95%CI:1.03~1.10;P<0.001)、持续性AF(OR=4.92,95%CI:2.72~8.93,P<0.001)、左室射血分数(LVEF)(OR=0.95,95%CI:0.92~0.99,P=0.009)和左房直径(LAD)(OR=1.15,95%CI:1.09~1.22,P<0.001)是AF合并中、重度FMR的独立危险因素。对AF合并中、重度FMR组患者进行随访(23.3±6.7)个月,与术前相比,维持窦律患者LAD明显减小[(44.1±5.1)mm∶(41.6±5.6)mm,P=0.002],FMR程度明显改善(P=0.001)。而AF复发患者FMR较术前无明显改善(P=0.058),LAD亦未见明显降低(P>0.05)。结论:年龄、持续性AF、LVEF及LAD是AF合并中、重度FMR的独立危险因素,AF合并中、重度FMR患者经导管消融维持窦性心律能显著改善FMR程度。Objective: To investigate the risk factors of atrial fibrillation(AF) patients with moderate and severe functional mitral regurgitation(FMR) and the effect of AF catheter ablation on FMR. Methods: Among the patients who received AF catheter ablation for the first time, 88 patients with moderate and severe FMR and 277 patients with no or mild FMR were continuously selected in our hospital from January 2018 to December 2019. The baseline data of the two groups were compared, and the risk factors of moderate and severe FMR in AF were evaluated by logistics regression analysis. The patients with AF combined with moderate and severe FMR were divided into the maintenance of sinus rhythm group and the recurrence of AF group according to whether AF recurrence occurred after operation, and the results of cardiac color doppler ultrasound before and after operation were compared between the two groups. Results: Multifactor Logistics regression analysis showed that: Age(OR=1.07, 95%CI: 1.03-1.10, P<0.001), persistent AF(OR=4.92, 95%CI: 2.72-8.93, P<0.001), left ventricular ejection fraction(LVEF)(OR=0.95, 95%CI: 0.92-0.99, P=0.009) and left atrial diameter(LAD)(OR=1.15, 95%CI: 1.09-1.22, P<0.001) were independent risk factors for AF with moderate and severe FMR. The patients with AF combined with moderate and severe FMR were followed up for(23.3±6.7) months. Compared with the pre-operation, the LAD of patients with maintenance of sinus rhythm was significantly decreased[(44.1±5.1) mm vs.(41.6±5.6) mm, P=0.002], and the degree of FMR was significantly improved(P=0.001). In patients with AF recurrence, FMR was not significantly improved(P=0.058) and LAD was not significantly decreased(P>0.05). Conclusion: Age, persistent AF, LVEF and LAD were independent risk factors for AF with moderate and severe FMR, and catheter ablation to maintain sinus rhythm could significantly improve the degree of FMR in AF with moderate and severe FMR.

关 键 词：心房颤动 中、重度功能性二尖瓣反流 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]