左心疾病相关肺动脉高压患者的心律失常患病率及相关因素  

Prevalence and related factors of arrhythmia in patients with left heart disease-related pulmonary hypertension

作　　者：刘创星 孟哲[1] 邢钰[1] 李铭瑄 辜和平 LIU Chuangxing;MENG Zhe;XING Yu;LI Mingxuan;GU Heping(Department of Cardiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China)

机构地区：[1]郑州大学第一附属医院心内科,郑州450052

出　　处：《临床心血管病杂志》2023年第1期10-15,共6页Journal of Clinical Cardiology

摘　　要：目的:分析左心疾病相关肺动脉高压(PH-LHD)患者不同类型心律失常的患病率及相关因素。方法:连续收集2021年1月—2021年2月于我院住院的PH-LHD患者共500例,根据常规心电图或24 h动态心电图记录心律失常发生情况;将所有患者的一般临床资料、心脏超声参数作为自变量,有无合并心房颤动(房颤)/室性心动过速(室速)/窦房结功能障碍或房室传导阻滞(缓慢型心律失常)作为因变量,运用单因素logistic回归分别分析PH-LHD合并不同类型心律失常的相关因素,进一步将单因素分析中有意义的变量作为自变量进行多因素logistic回归分析。结果:500例PH-LHD患者中,45%合并高血压,其他依次为冠心病(38.4%)、心脏瓣膜病(19.6%)、扩张型心肌病(15.2%)。任何心律失常、室上性心动过速、窦性心动过速、房性心动过速、房颤、心房扑动、房室折返性心动过速、房室结折返性心动过速、室速、窦房结功能障碍、房室传导阻滞的发病率分别为77.4%、66.6%、22.6%、17.8%、35%、5.6%、1%、0.6%、18.4%、11.2%、16%,合并房颤患者中80%为持续性;多因素logistic回归分析结果显示,女性(OR=1.739,P=0.037)、年龄增大(OR=1.065,P=0.001)、左房内径增大(OR=1.084,P=0.001)、右房内径增大(OR=1.092,P=0.001)与PH-LHD患者合并房颤独立相关;肺动脉收缩压(PASP)升高(OR=1.020,P=0.035)、合并冠心病(OR=1.898,P=0.013)与PH-LHD患者合并室速独立相关;男性(OR=1.617,P=0.041)、年龄增大(OR=1.027,P=0.001)、右房内径增大(OR=1.032,P=0.005)与PH-LHD患者合并缓慢型心律失常独立相关。结论:3/4以上的PH-LHD患者合并心律失常,以室上性心动过速多见,亚型中以持续性房颤最常见;PASP及右房结构改变与PH-LHD发生心律失常的相关性较左心系统更显著,其中PASP升高与PH-LHD发生室速独立相关,右房内径增大与PH-LHD患者发生房颤、缓慢型心律失常均独立相关。Objective: To analyze the prevalence and related factors of different types of arrhythmia in patients with left heart disease-related pulmonary hypertension(PH-LHD). Methods: A total of 500 patients with PH-LHD who were hospitalized in our hospital from January 2021 to February 2021 were continuously collected, and the occurrence of arrhythmia was recorded according to regular ECG or 24 h Holter. The general clinical data and cardiac ultrasound parameters of all patients were taken as independent variables, and whether there were or without atrial fibrillation(AF)/ventricular tachycardia(VT)/sinoatrial node dysfunction or atrioventricular block(bradyarrhythmia) as the dependent variables, and the related factors of PH-LHD combined with different types of arrhythmias were analyzed separately using univariate logistic regression, and the meaningful variables in the univariate analysis were further analyzed as independent variables for multivariate logistic regression. Results: Among the 500 patients with PH-LHD, 45% had hypertension, followed by coronary heart disease(38.4%), valvular heart disease(19.6%), and dilated cardiomyopathy(15.2%). The incidence of any arrhythmia, supraventricular tachycardia, sinus tachycardia, atrial tachycardia, atrial fibrillation, atrial flutter, atrioventricular reentrant tachycardia, atrioventricular node reentrant tachycardia, ventricular tachycardia, sinus node dysfunction, and atrioventricular block was 77.4%, 66.6%, 22.6%, 17.8%, 35%, 5.6%, 1%, 0.6%, 18.4%, 11.2%, and 16%, respectively, and 80% of patients with AF were persistent;The results of multivariate logistic regression analysis showed that female(OR=1.739, P=0.037), age increase(OR=1.065, P=0.001), left atrial diameter increase(OR=1.084, P=0.001), and right atrial diameter increase(OR=1.092, P=0.001) were independently associated with AF in patients with PH-LHD. Elevated pulmonary artery systolic blood pressure(PASP)(OR=1.020, P=0.035), and coronary heart disease(OR=1.898, P=0.013) were independently associated with VT i

关 键 词：肺动脉高压 左心疾病 心律失常 患病率 相关因素 

分 类 号：R543.2[医药卫生—心血管疾病]