心动过速性心肌病的临床特点分析  

Analysis on clinical characteristics of tachycardia-induced cardiomyopathy

作　　者：周应秋 李庆 张国菊 何忠荣 郭金锐 ZHOU Ying-qiu;LI Qing;ZHANG Guo-Ju;HE ZHONG-Rong;GUO Jin-rui(Department of Cardiology,Fuwai Yunnan Cardiovascular Hospital/Cardiovascular Hospital Affiliatedto Kunming Medical University,Kunming Yunnan 650102,China)

机构地区：[1]云南省阜外心血管病医院/昆明医科大学附属心血管病医院心内科,云南昆明650102

出　　处：《云南医药》2022年第6期33-37,共5页Medicine and Pharmacy of Yunnan

基　　金：云南省心血管病临床医学中心项目(FZX2019);云南省心血管系统疾病临床医学研究中心-重大心血管疾病诊治新技术研发项目(202102AA310002);云南省阜外心血管病医院心力衰竭诊疗省创新团队项目(202005AE160020)。

摘　　要：目的探讨持续性心房颤动合并心脏扩大,心功能下降患者的诊断及治疗,甄别心动过速性心肌病。方法回顾性纳入2017年9月-2020年4月云南省阜外医院持续心房颤动合并心脏扩大,LVEF小于50%的46例患者,经积极药物治疗或导管消融治疗后,6月内LVEF上升15%或恢复正常定义为心动过速性心肌病,反之为扩张型心肌病.比较2组人群首次诊断LA,LVEF,LVEDD,NT-pro BNP,NYHA分级等指标。结果(1)与DCM相比,TIC患者LVEDD(P<0.001)、LA(P=0.048)均更小。(2)TIC组14人(47%)首次就诊时被误诊为DCM,4人(20%)被误诊为心脏瓣膜病,仅4人(17%)被正确诊断为TIC;结论TIC最容易被误诊为DCM。与DCM相比,TIC患者心功能分级更低,LVEDD更小可与之鉴别。导管消融房颤较药物治疗明显改善患者LVEF。Objective To explore the diagnosis and treatment of patients with persistent atrial fibrillation combined with cardiac enlargement and decreased cardiac function,and to identify tachycardia-induced cardiomyopathy(TIC).Methods 46 patients with persistent atrial fibrillation and cardiac enlargement,LVEF was less than 50%who were admitted in Fuwai Cardiovascular Hospital of Yunnan Province from September 2017 to April 2020.After active treatment of drug or catheter ablation,the LVEF went up 15%or returned to normal defined tachycardiomyopathy within 6 months,otherwise,it was defined as dilated cardiomyopathy.The index of first diagnose of LA,LVEF,LVEDD,NT-pro BNP,NYHA classification were compared between the two groups.Results 1.Compared with DCM,patients with TIC had smaller left ventricular end-diastolic diameter(LVEDD)(P<0.001)and left atrial diameter(LA)(P=0.048).2,In the TIC group,14(47%)patients were misdiagnosed as DCM at the first visit,4 patients(20%)were misdiagnosed as valvular heart disease,and only 4 patients(17%)were correctly diagnosed as TIC.Conclusions TIC is most likely to be misdiagnosed as DCM.Compared with DCM,TIC patients have lower cardiac function grades,and smaller LVEDD.Catheter ablation of atrial fibrillation significantly improves patients’LVEF compared with drug therapy.

关 键 词：心房颤动 心力衰竭 导管消融 

分 类 号：R542.2[医药卫生—心血管疾病]