心脏起搏器导线相关三尖瓣返流的单中心回顾性分析  

A single-center retrospective analysis of pacemaker lead-associated tricuspid regurgitation

作　　者：李腾 周彬 李华龙 李超 彭文杰 梁建 邹春霞 张道良 李宜富 廖志勇 王靖 丁立刚 钟新波 姚焰 颜红兵 LI Teng;ZHOU Bin;LI Hua-long;LI Chao;PENG Wen-jie;LIANG Jian;ZOU Chun-xia;ZHANG Dao-liang;LI Yi-fu;LIAO Zhi-yong;WANG Jin;DING Li-gang;ZHONG Xin-bo;YAO Yan;YAN Hong-bin(Shenzhen Hospital of Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen 518057,Guangdong,China)

机构地区：[1]中国医学科学院阜外医院深圳医院,广东深圳518057

出　　处：《中国心脏起搏与心电生理杂志》2023年第4期303-305,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：深圳市医疗卫生“三名”工程基金(SZSM201911017);深圳市重点医学学科建设基金(SZXK00181);心原性休克的评估体系和干预策略研究(2019ZT08Y481)。

摘　　要：目的 回顾性分析单中心心脏起搏器导线相关三尖瓣返流(TR)的状况。方法 连续入选2018年1月至2022年5月在中国医学科学院阜外医院深圳医院心内科行心脏起搏器植入的患者。统计患者一般临床资料及相关数据。通过心脏超声心动图对比分析术后TR程度定义加重2级及以上为TR进展。通过logistic回归分析影响TR进展的相关因素。结果 1 007例患者通过纳排标准后共入选553例患者。其中,男性279例,女性274例,年龄(64.7±15.1)岁。随访中位数316天,346例(62.6%)TR无变化,45例(8.1%)TR得到改善,140例(25.3%)TR加重一级,22例(4%)TR加重二级。与TR无进展组(n=531)相比,TR进展组(n=22)心房颤动占比、心力衰竭占比更高,左房前后径、左室舒张末径更大,左室射血分数更低(均P<0.05)。多因素logistic回归分析显示,术前患有心房颤动,术后TR进展占比更高[OR 4.28 (1.6~11.42),P=0.004]。结论 心脏起搏器术后TR进展发生率较低,术前患有心房颤动是TR进展的独立危险因素。Objective Retrospective analysis of the status of pacemaker lead-related tricuspid regurgitation(TR)in a single center.Method Consecutive patients who underwent pacemaker implantation at the Department of Cardiology,Shenzhen Hospital of Fuwai Hospital Chinese Academy of Medical Sciences,from January 2018to May 2022were retrospectively enrolled for analysis.The general clinical data and related data of the patients were counted.Postoperative TR degree aggravation of grade 2and above was defined as TR progressionby comparative analysis using cardiac echocardiography.The correlated factors affecting TR progression were ana-lyzed by logistic regression.Result After screening by inclusion and exclusion criteria,553patients were en-rolled out of 1007patients.Among them,279were men and 274were women,aged(64.7±15.1)years.At a median follow-up of 316days,346cases(62.6%)had no change in TR,45 cases(8.1%)had improved TR,140cases(25.3%)had worsened TR grade I,and 22cases(4%)had worsened TR grade II.Compared with the TR non-progressive group(n=531),the TR-progressive group(n=22)had a higher proportion of atrial fibrilla-tion and heart failure,a larger anterior-posterior left atrial diameter and left ventricular end-diastolic diameter,and a lower left ventricular ejection fraction(all P<0.05).Multivariate logistic regression analysis showed that the pro-portion of postoperative TR progression was higher with preoperative atrial fibrillation[OR 4.28(1.6-11.42),P=0.004].Conclusion The incidence of TR progression after pacemaker implantion is low,and preoperative atrial fibrillation is an independent risk factor for TR progression.

关 键 词：心血管病学 心脏起搏器 三尖瓣返流 心房颤动 

分 类 号：R541.75[医药卫生—心血管疾病] R318.11[医药卫生—内科学]