非ST段抬高型急性冠状动脉综合征患者心肌纤维化与心律失常风险关系的研究  

Study on the relationship between myocardial fibrosis and the risk of ventricular arrhythmia in patients with non-ST-segment elevation acute coronary syndrome

作　　者：张锋[1] 祖晓麟[1] 曾玉杰[1] ZHANG Feng;ZU Xiaolin;ZENG Yujie(Department of Cardiology,Emergency Coronary Artery Unit,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内急诊冠状动脉病房,100029

出　　处：《心肺血管病杂志》2023年第3期199-203,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探评估心脏MR检测的心肌纤维化(MF)对非ST抬高型急性冠状动脉综合征(NST-ACS)患者随访发生室性心律失常风险的影响。方法:回顾性选取273例2017年1月至2019年6月,我院收治的NST-ACS且放置置入式心律转复除颤器(ICD)的患者,根据入院时心脏MR检查是否合并心肌纤维化分为MF组(n=184)和对照组(n=89)。其中男性162例(59.3%),女性111例(40.7%)。年龄38~79岁,平均年龄(52.6±15.3)岁。出院后3,6和12个月分别到随访门诊随访,根据ICD监测情况,记录患者的主要重点事件:恶性室性心律失常(室性心动过速和心室颤动)和心脏骤停的发生风险。KM生存分析评估两组间的终点事件发生率,Logistic回归分析评估影响终点事件的相关因素。ROC曲线评估心肌纤维化对终点事件的判断价值。结果:两组患者的陈旧心肌梗死、脑血管疾病、TNI、CK-MB、NTproBNP和β受体阻滞剂等,均差异有统计学意义(P <0.05)。平均随访时间为(12.3±2.5)个月,失访44例(16.1%)。共有62例(22.7%)终点事件,MF组和对照组分别有47例(25.5%)和15例(16.9%),生存分析结果显示,MF组的终点事件发生率(HR=1.667,95%CI:1.107~2.835,P=0.034)显著高于对照组,但两组的心脏骤停(P=0.307)风险相似。Logistic回归分析结果显示,MF(OR=1.732,P=0.013),TNI(OR=1.501,P=0.018)、NTproBNP(OR=1.817,P=0.022)是发生终点事件的因素,β受体阻滞剂(OR=0.833,P=0.004)可降低终点事件发生风险。ROC曲线显示,MF诊断终点事件的价值较大,AUC为0.731(95%CI:0.638~0.864)。结论:MF可显著增加NST-ACS患者恶性室性心律失常的发生风险。Objective:To evaluate the effect of myocardial fibrosis(MF)detected by cardiac MR on the risk of ventricular arrhythmia in follow-up patients with non-ST elevation acute coronary syndrome(NSTACS).Methods:This was a retrospective study.A total of 273 patients with NST-ACS and implantable cardial defibrillator who were admitted to our hospital from January 2017 to June 2018 were enrolled.According to the presence or absence of MF detected by cardiac MR eexamination performed after admission,all patients were divided into MF group (n=184) and control group (n=89). Among them, there were 162 males (59.3%) and 111 females (40.7%). The age was 38-79 years old, with an average of (52.6±15.3) years. At 3, 6 and 12 months after discharge, all were followed at outpatient department, and the rate of primary outcome [malignant ventricular arrhythmia (ventricular tachycardia and ventricular fibrillation) and cardiac arrest] which were detected by ICD was recorded. KM survival analysis was used to assess the incidence of end-point events between the two groups, logistic regression analysis to assess its associated factors, and receiver operating characteristic (ROC) curve to evaluate the predictive value of MF for primary outcome. Results: There were significant differences in the rates of previous myocardial infarction, cerebrovascular disease, levels of troponin I, CK-MB, NT-pro BNP and β-blockers (P<0.05). The average follow-up time was (12.3±2.5) months, and 44 cases (16.1%) were lost to follow-up. A total of 62 (22.7%) cases had primary outcome, and there were 47 (25.5%) and 15 (16.9%) cases in the MF group and the control group, respectively. The results of survival analysis showed that the end-point event rate in the MF group (HR=1.667, 95%CI:1.107- 2.835, P=0.03) was significantly higher than the control group, but the risk of cardiac arrest (P=0.307) was similar in the two groups. The results of logistic regression analysis showed that MF (OR=1.732, P=0.013), TNI (OR=1.501, P=0.018), NT-proBNP (OR=1.817, P=0.022) w

关 键 词：非ST抬高型ACS 心肌纤维化 室性心律失常 

分 类 号：R54[医药卫生—心血管疾病]