老年射血分数保留心力衰竭合并心房颤动患者的心脏结构功能改变及其表型分析  

Structural and functional cardiac changes in the elderly patients with heart failure with preserved ejection fraction and atrial fibrillation and an analysis on its two phenotypes

作　　者：贾晓艳 刘永铭[2] 彭可玲 杨京港[2] 刘艳英[2] 苟春丽 薛丽丽[3] 马苏美[3] 邹全[3] Jia Xiaoyan;Liu Yongming;Peng Keling;Yang Jinggang;Liu Yanying;Gou Chunli;Xue Lili;Ma Sumei;Zou Quan(The First Clinical School of Medicine,Lanzhou University,Lanzhou 730000,China;Department of Geriatric Cardiology,The First Hospital of Lanzhou University,Gansu Provincial Clinical Research Center for Geriatric Medicine,Lanzhou 730000,China;Department of Ultrasound Diagnosis,The First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院老年心血管科/甘肃省老年疾病临床医学研究中心,兰州730000 [3]兰州大学第一医院超声诊断科,兰州730000

出　　处：《中华老年医学杂志》2023年第10期1153-1160,共8页Chinese Journal of Geriatrics

基　　金：甘肃省重点研发计划(20YF8FA079)。

摘　　要：目的观察老年射血分数保留心力衰竭(HFpEF)合并心房颤动(房颤,AF)患者的临床表现和心脏结构功能改变。方法横断面研究,连续纳入2009年4月至2020年12月兰州大学第一医院老年心血管科收治的年龄≥60岁的HFpEF患者835例,根据是否合并AF,分为HFpEF+AF组(267例)和HFpEF组(568例),评价其心脏结构功能。根据ROC分析二尖瓣血流频谱舒张早期峰值速度(E)与二尖瓣环舒张早期最大速度(e')比值(E/e')的最佳切点,将HFpEF+AF分为E/e'>11和E/e'≤11两个亚组,比较其临床表现、心脏结构功能差异以及左心与右心的关系。结果HFpEF+AF组左心房容积指数(LAVi)大于HFpEF组[(60.0±23.3)ml/m2比(43.9±19.0)ml/m2,t=10.130,P<0.01],而左心室射血分数、二尖瓣环间隔部收缩速度(s'S)、E/e'小于HFpEF组(均P<0.01),右心室内径、右心房内径和面积、三尖瓣反流速度以及肺动脉压均大于HFpEF组(均P<0.05)。相对于E/e'≤11亚组,E/e'>11亚组高血压、冠心病、糖尿病患病率更高、病程更长,s'下降更严重(均P<0.05),E/e'与LAVi,LAVi与肺动脉收缩压(PASP)均独立相关(t=2.114和1.963,P=0.034和0.042),上述表现与HFpEF组相似。而E/e'≤11亚组较E/e'>11亚组女性比例较高,房颤病程更长(中位:5年比1年,P=0.003);右心室、右心房扩大更明显,三尖瓣反流速度及PASP升高更严重(均P<0.05)。结论老年HFpEF合并AF的左心房容积进一步增大,左心室收缩功能及右心结构损害更加严重,并且可能存在两种病理生理机制不同的表型。Objective To investigate the clinical characteristics and structural and functional cardiac changes in heart failure with preserved ejection fraction(HFpEF)complicated with atrial fibrillation(AF)in elderly patients.Methods As a cross-sectional study,835 patients with HFpEF aged≥60 years admitted to the Department of Geriatric Cardiovascular Medicine of the First Hospital of Lanzhou University between April 2009 and December 2020 were divided into an HFpEF+AF group(267 cases)and an HFpEF group(568 cases)according to whether they had AF in addition to HFpEF,and their cardiac structure and function were evaluated.The optimal cutoff point of the ratio of the peak early diastolic velocity(E)to the maximum early diastolic velocity(e')of the mitral annulus(E/e')was analysed using the receiver operating characteristic(ROC)curve.The HFpEF+AF group was divided into two subgroups,E/e'>11 and E/e'≤11,and differences in their clinical presentation,cardiac structural and function,and the relationship between the left and right heart were compared.Results Compared with the HFpEF group,the left atrial volume index(LAVi)was larger[(60.0±23.3)ml/m2vs.(43.9±19.0)ml/m2,t=10.130,P<0.01]and the left ventricular ejection fraction(EF),mitral annular septal systolic velocity(s'S)and E/e'were smaller than in the HFpEF+AF group(all P<0.01),whereas the right ventricular diameter(RVD),right atrial diameter(RAD)and area(RAA),tricuspid regurgitation velocity(TRv),and pulmonary arterial systolic pressure(PASP)in the HFpEF+AF group were all greater than those in the HFpEF group(all P<0.05).In the E/e'>11 subgroup of HFpEF+AF,the prevalence of hypertension,coronary heart disease and diabetes were higher,AF courses were shorter,and the decline of s'was more severe(all P<0.05).Furthermore,E/e'was independently correlated with LAVi,as was LAVi with PASP(t=2.114,1.963,P=0.034,0.042).The above-mentioned features were similar to those in the HFpEF group.The E/e'≤11 subgroup had a higher proportion of women,longer duration of AF than the E/e'>1

关 键 词：心力衰竭 心房颤动 心室重构 心室功能 表型 

分 类 号：R541.6[医药卫生—心血管疾病] R541.75[医药卫生—内科学]