左心室心肌致密化不全患者的临床特征及伴发心房颤动的相关因素分析  

Clinical Characteristics of Patients With Left Ventricular Non-compaction and Predictors for the Occurrence of Atrial Fibrillation

作　　者：蔡锶敏 董雨辰 王现青[2] 郑黎晖[1] 刘立旻[1] 姚焰[1] CAI Simin;DONG Yuchen;WANG Xianqing;ZHENG Lihui;LIU Limin;YAO Yan(National Clinical Medical Research Center for Cardiovascular Diseases,Cardiac Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Heart Center,Henan Provincial People's Hospital,Center of Arrhythmia,Fuwai Central China Cardiovascular Hospital,Zhengzhou 451464,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心律失常中心国家心血管疾病临床医学研究中心,北京100037 [2]河南省人民医院心脏中心阜外华中心血管病医院心律失常中心,郑州451464

出　　处：《中国循环杂志》2023年第11期1119-1126,共8页Chinese Circulation Journal

基　　金：国家自然科学青年基金项目(82000323);国家重点研发计划(2017YFC1307800);中国医学科学院阜外医院国家心血管疾病临床医学研究中心自主课题(NCRC2020012)。

摘　　要：目的:分析左心室心肌致密化不全(LVNC)的临床特征,探索与LVNC伴发心房颤动相关的影响因素。方法:入选中国医学科学院阜外医院2015年1月至2020年10月收治的LVNC患者153例,所有患者均完善静息心电图、24小时动态心电图、经胸超声心动图(TTE)及心脏磁共振成像(CMR)等检查,并测定血浆大内皮素-1、N末端B型利钠肽原(NT-proBNP)等化验指标。根据病史、静息心电图、24小时动态心电图结果将LVNC患者分为合并心房颤动组(n=23)和无心房颤动组(n=130),对两组患者的临床表现、实验室检测结果及影像学特征进行统计学分析。结果:与无心房颤动组比,合并心房颤动组患者发生心悸和血栓栓塞事件的比例更高,心功能更差(P均<0.05);合并心房颤动组患者血浆大内皮素-1及NT-proBNP水平显著升高,TTE测量的左心房前后径(LAD)明显增大,CMR检查显示钆延迟增强(LGE)阳性率较高(P均<0.05)。多因素Logistic回归分析显示,血浆大内皮素-1升高(OR=2.249,95%CI:1.061~4.770,P=0.035)、LAD增大(OR=1.128,95%CI:1.046~1.216,P=0.002)和发生血栓栓塞事件(OR=3.312,95%CI:1.041~10.541,P=0.043)是LVNC患者伴发心房颤动的独立预测指标。结论:大内皮素-1水平和LAD与LVNC合并心房颤动独立相关,定期监测大内皮素-1水平和LAD有助于预估LVNC患者发生心房颤动的风险。Objectives:To analyze the clinical characteristics of left ventricular non-compaction(LVNC)and explore the relative factors for atrial fibrillation(AF)in patients with LVNC.Methods:A total of 153 LVNC patients admitted to Fuwai Hospital from January 2015 to October 2020 were included in this analysis.Patients were divided into the AF group(n=23)and non-AF group(n=130)according to electrocardiography(ECG)and 24-h continuous ambulatory ECG.Clinical characteristics,results of transthoracic echocardiography(TTE)and cardiac magnetic resonance examinations,and the plasma level of big endothelin-1(Big ET-1)and N-terminal pro-brain natriuretic peptide(NT-proBNP)were compared between the two groups.Results:AF group had a higher incidence of palpitation and thromboembolism,and a worse cardiac function than non-AF group(all P<0.05);plasma levels of Big ET-1 and NT-proBNP,left atrial anteroposterior diameter(LAD)measured by TTE,positive rate of late gadolinium enhancement were significantly higher in AF group than in non-AF group(all P<0.05).Multivariate logistic regression showed that ln Big ET-1(OR=2.249,95%CI:1.061-4.770,P=0.035),LAD(OR=1.128,95%CI:1.046-1.216,P=0.002),and thromboembolism(OR=3.312,95%CI:1.041-10.541,P=0.043)were the independent risk factors of AF in LVNC patients.Conclusions:Big ET-1 and LAD are independent predictors for AF in LVNC patients.Regular monitoring of the plasma level of Big ET-1 and LAD may be helpful for the early diagnosis and prediction of AF occurrence in LVNC patients.

关 键 词：左心室心肌致密化不全 心房颤动 大内皮素-1 血栓栓塞 

分 类 号：R54[医药卫生—心血管疾病]