左心房增大对心脏起搏器术后老年阵发性心房颤动患者脑卒中等终点事件的影响  

Effects of left atrial enlargement on stroke and thromboembolic events in elderly PAF patients after cardiac pacemaker implantation

作　　者：王海军[1] 王璐[1] 王霞 郭艳[1] 帅莉[1] 史扬[1] Wang Haijun;Wang Lu;Wang Xia;Guo Yan;Shuai Li;Shi Yang(Department of Cardiovascular Diseases,Second Medical Center&National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心心血管内科,国家老年疾病临床医学研究中心,北京100853 [2]中央军委联合参谋部警卫局卫生保健处

出　　处：《中华老年心脑血管病杂志》2022年第11期1124-1127,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家老年疾病临床医学研究中心开放课题(NCRCG-PLAGH-2019021);军队保健专项科研课题(18BJZ32)。

摘　　要：目的探讨左心房增大对置入心脏起搏器的老年阵发性心房颤动(房颤)患者脑卒中等血栓事件的影响。方法对2013年1月至2015年6月在解放军总医院第二医学中心起搏器门诊长期随访的未服用抗凝药物的老年阵发性房颤患者148例,记录基线特征、随访期间血栓终点事件及临床终点事件发生情况,按随访期间有无血栓终点事件发生分为血栓组43例,对照组105例。进行Cox回归分析探讨左心房增大对血栓终点事件的影响。结果与对照组比较,血栓组年龄、冠心病、脑卒中/短暂性脑缺血发作、2型糖尿病、慢性肾功能不全的比例显著增高(P<0.05,P<0.01)。平均随访时间为22.79个月,Kaplan-Meier生存曲线分析显示,慢性肾功能不全或左心房增大的患者血栓终点事件发生率显著升高(P<0.05,P<0.01)。多因素Cox回归分析显示,脑卒中/短暂性脑缺血发作(HR=2.561,95%CI:1.382~4.749,P=0.003)、2型糖尿病(HR=2.562,95%CI:1.353~4.851,P=0.004)、左心房增大(HR=2.161,95%CI:1.085~4.305,P=0.028)及慢性肾功能不全(HR=3.609,95%CI:1.849~7.043,P=0.000)是入选的起搏器置入术后老年房颤患者脑卒中等血栓终点事件的独立危险因素。结论左心房增大是起搏器置入术后未服用抗凝药物的老年阵发性房颤患者发生脑卒中等血栓事件的独立危险因素。Objective To investigate the impacts of left atrial enlargement on the risks of strokes and thromboembolic events in elderly paroxysmal atrial fibrillation(PAF)patients with implanted cardiac pacemakers.Methods A total of 148 elderly PAF patients after cardiac pacemaker implantation without anticoagulation therapy who received long-term follow-up in our pacemaker clinic between January 2013 and June 2015 were enrolled in this observational study.The baseline characteristics and clinical adverse events during the observation period were recorded.Patients were divided into the thrombosis group(n=43)and the control group(n=105)according to whether there was thromboembolic event during follow-up.Cox regression analysis was conducted to investigate the effect of left atrial enlargement on thromboembolic events.Results The proportions of older age,coronary heart disease,stroke/transient ischemic attack,type 2 diabetes mellitus and chronic renal insufficiency were significantly higher in the thrombosis group than the control group(P<0.05,P<0.01).During an average follow-up period of 22.79 months,Kaplan-Meier survival curve analysis showed that the patients with chronic renal insufficiency or left atrial enlargement had a significantly higher incidence of thromboembolic events(P<0.05,P<0.01).Multivariate Cox regression analysis showed that stroke/transient ischemic attack(HR=2.561,95%CI:1.382-4.749,P=0.003),type 2 diabetes mellitus(HR=2.562,95%CI:1.353-4.851,P=0.004),left atrial enlargement(HR=2.161,95%CI:1.085-4.305,P=0.028)and chronic renal insufficiency(HR=3.609,95%CI:1.849-7.043,P=0.000)were independent risk factors for thromboembolic events in elderly AF patients after pacemaker implantation.Conclusion Left atrial enlargement is an independent risk factor for strokes and thromboembolic events in elderly patients with PAF after cardiac pacemaker implantation without anticoagulation therapy.

关 键 词：心房颤动 心脏起搏器 人工 卒中 血栓栓塞 左心房容积指数 

分 类 号：R541.75[医药卫生—心血管疾病] R743.3[医药卫生—内科学]