功能性二尖瓣反流与心房颤动射频消融术后早期心力衰竭的相关性  

Correlation between functional mitral regurgitation and early heart failure after radiofrequency ablation of atrial fibrillation

作　　者：王芳 段续敏 卫政 褚婷婷 廉玉蓉 Wang Fang;Duan Xumin;Wei Zheng;Chu Tingting;Lian Yurong(Department of Cardiovascular Medicine,Linfen People’s Hospital Affiliated to the Seventh Clinical Medical College of Shanxi Medical University,Lin Fen 041000,China)

机构地区：[1]山西医科大学第七临床医学院附属临汾市人民医院心血管内科,山西临汾041000

出　　处：《临床内科杂志》2024年第10期678-682,共5页Journal of Clinical Internal Medicine

基　　金：临汾市重点研发计划资助项目(2134)。

摘　　要：目的分析心房颤动(AF)射频消融术后早期心力衰竭(简称心衰)发生的危险因素,评估功能性二尖瓣反流(FMR)与AF射频消融术后早期心衰发生的关系。方法纳入2018年4月~2022年9月在我院行AF射频消融术的患者257例,根据术后1周内是否出现急性心衰,将其分为无早期心衰组(234例)及早期心衰组(23例)。收集所有患者术前血清学指标、超声心动图及射频消融术式等临床资料及术后随访情况并分组进行比较。采用单因素和多因素logistic回归分析评估AF患者行射频消融术后发生早期心衰的危险因素。结果257例患者中出现早期心衰23例,发生率为8.9%。早期心衰组年龄、非瓣膜病性房颤卒中风险评分(CHA2DS2-VASc评分)、抗凝出血风险评分(HAS-BLED评分)、左心房前后径及合并2型糖尿病、中重度FMR、持续性AF及PVI+线性消融手术方式患者比例均高于无早期心衰组,肌酐清除率(GFR)低于无早期心衰组(P<0.05)。多因素logistic回归结果显示,持续性AF、合并中重度FMR及2型糖尿病均是AF射频消融术后患者出现早期心衰的独立危险因素(P<0.05)。两组心衰再住院、AF复发、死亡患者比例及生存曲线比较差异均无统计学意义(P>0.05)。结论AF射频消融术后早期心衰有一定的发生率,合并中重度FMR为AF射频消融术后出现早期心衰的独立危险因子。Objective To analyze the risk factors of early heart failure after radiofrequency ablation of atrial fibrillation(AF),and to evaluate the relationship between functional mitral regurgitation(FMR)and early heart failure after radiofrequency ablation of AF.Methods A total of 257 patients who underwent AF radiofrequency ablation in our hospital from April 2018 to September 2022 were enrolled.According to whether acute heart failure occurred within 1 week after surgery,they were divided into nonearly heart failure group(234 cases)and early heart failure group(23 cases).Clinical data such as preoperative serological indicators,echocardiography,radiofrequency ablation and postoperative follow⁃up of all patients were collected and grouped for comparison.Univariate and multivariate logistic regression analysis were used to evaluate the risk factors of early heart failure after radiofrequency ablation in patients with AF.Results The incidence of early heart failure was 8.9%(23/257).Age,stroke risk score for nonvalvular atrial fibrillation(CHA2 DS2⁃VASc score),anticoagulant bleeding risk score(HAS BLED score),left atrium diameter and merger,proportion of patients with type 2 diabetes mellitus,moderate to severe FMR,persistent AF and PVI+linear ablation in heart failure group were higher than those in nonearly heart failure group,creatinine clearance(GFR)was lower than that in non⁃early heart failure group(P<0.05).Multivariate logistic regression analysis showed that persistent AF,complicated with moderate to severe FMR and type 2 diabetes mellitus were independent risk factors for early heart failure in patients with AF after radiofrequency ablation(P<0.05).There were no significant differences in the rates of HF rehospitalization,AF recurrence,death and survival curves between the two groups(P>0.05).Conclusion There is a certain incidence of early heart failure after AF radiofrequency ablation,and moderate to severe FMR is an independent risk factor for early heart failure after AF radiofrequency ablation.

关 键 词：心房颤动 射频导管消融 功能性二尖瓣反流 心力衰竭 

分 类 号：R541.75[医药卫生—心血管疾病]