肥厚型心肌病合并心房颤动患者的心血管死亡和猝死风险评估  

The Risk Assessment of Cardiovascular Death and Sudden Death in Patients with Hypertrophic Cardiomyopathy Combined with Atrial Fibrillation

作　　者：彭韵朴 谭震 刘磊 刘益均[1] 任宏强 PENG Yunpu;TAN Zhen;LIU Lei;LIU Yijun;REN Hongqiang(Department of Cardiology,Suining Central Hospital,Suining 629000,Sichuan,China)

机构地区：[1]遂宁市中心医院心血管内科,四川遂宁629000

出　　处：《心血管病学进展》2024年第11期1051-1056,共6页Advances in Cardiovascular Diseases

摘　　要：目的该研究旨在评估肥厚型心肌病(HCM)合并心房颤动(房颤)患者的心血管死亡及猝死风险。方法本研究是一项回顾性研究,纳入2016年3月—2023年6月在遂宁市中心医院诊断HCM患者298例,记录患者一般资料及相关检查结果,采用电话或门诊随访,随访至2023年12月。使用Kaplan-Meier法绘制生存曲线,基于log-rank检验比较无房颤HCM患者与HCM合并房颤患者心血管死亡和猝死风险的差异。建立多因素Cox比例风险模型评估房颤与HCM患者心血管死亡和猝死的相关性。进一步采用竞争风险模型作为敏感性分析。结果无房颤HCM患者252例,HCM合并房颤患者46例。房颤组患者的纽约心功能分级较无房颤组患者差(P<0.001),而房颤组患者QT间期较无房颤组患者缩短(P<0.001),其左心房内径大于无房颤组患者(P<0.001)。Kaplan-Meier分析HCM合并房颤患者心血管死亡及猝死的累积发生率,结果提示房颤组患者心血管死亡及猝死风险均高于无房颤组患者(log-rank P=0.00017,log-rank P=0.017)。多变量Cox回归分析提示房颤与HCM患者心血管死亡和猝死相关(HR=2.846,95%CI 1.466~5.524,P=0.002;HR=3.829,95%CI 1.191~12.311,P=0.024)。竞争风险分析中Gray’s检验提示HCM合并房颤患者的猝死及竞争事件累积发生率较无房颤组患者更高(P=0.038,P=0.006)。将房颤、年龄、性别、体重指数、纽约心功能分级、左室射血分数、室性心动过速、左心室壁最大厚度、流出道梗阻纳入多变量竞争风险分析,提示房颤是HCM患者猝死的独立危险因素(HR=3.487,95%CI 1.002~12.152,P=0.046)。结论房颤与HCM患者心血管死亡和猝死相关,是HCM患者猝死的独立危险因素。Objective To investigate the risk of cardiovascular death and sudden death in patients with hypertrophic cardiomyopathy(HCM)combined with atrial fibrillation(AF).Methods This study is a retrospective study.298 patients with HCM diagnosed at the Suining Central Hospital from March 2016 to June 2023 were enrolled.Baseline data and examination results were collected for these patients.Follow-ups were conducted via phone or outpatient visit until December 2023.Survial curves were plotted using the Kaplan-Meier method,and the differences in risk of cardiovascular death and sudden death between HCM patients without AF and those with AF were compared using the log-rank test.Multivariate Cox proportional risk model was established to evaluate the association between AF and cardiovascular death and sudden death in patients with HCM.The competitive risk model was further used for sensitivity analysis.Results There were 252 HCM patients without AF and 46 HCM patients with AF.The New York Heart function assessment of patients in AF group was significantly poorer than that in non-AF group(P<0.001).Additionally,the QT interval in AF group was shorter compared to that in non-AF group(P<0.001),and the left atrial diameter was greater than that in non-AF group(P<0.001).Kaplan-Meier analysis of the cumulative incidence of cardiovascular death and sudden death in patients with HCM combined with AF showed that the risk of cardiovascular death and sudden death in patients with AF was higher than that in patients without AF(log-rank P=0.00017,log-rank P=0.017).Multivariate Cox regression analysis suggested that AF was associated with cardiovascular death and sudden death in HCM patients(HR=2.846,95%CI 1.466~5.524,P=0.002;HR=3.829,95%CI 1.191~12.311,P=0.024).In the competitive risk analysis,Gray’s test indicated that the risk of sudden death and the cumulative incidence of competitive events in AF HCM group was higher than that in the non-AF HCM group(P=0.038,P=0.006).AF,age,sex,body mass index,New York heart function assessment,left

关 键 词：肥厚型心肌病 心房颤动 心血管死亡 猝死 

分 类 号：R542.2[医药卫生—心血管疾病] R541.75[医药卫生—内科学]