非梗阻性肥厚型心肌病患者左心容积与心房颤动的相关性分析  

Correlation Analysis of Left Heart Volume and Atrial Fibrillation in Patients With Non-obstructive Hypertrophic Cardiomyopathy

作　　者：杨盼 肖明虎 唐亚捷 卫青 权欣 吴伟春 宋雷 朱振辉 YANG Pan;XIAO Minghu;TANG Yajie;WEI Qing;QUAN Xin;WU Weichun;SONG Lei;ZHU Zhenhui(Ultrasound Imaging Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Adult Surgical Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Cardiomyopathy Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,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、阜外医院超声影像中心,北京100037 [2]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院成人外科中心,北京100037 [3]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院心肌病中心,北京100037

出　　处：《中国循环杂志》2025年第3期240-245,共6页Chinese Circulation Journal

基　　金：中国医学科学院阜外医院特色学科发展基金(2022-FWTS09)。

摘　　要：目的:分析单心动周期实时全容积三维超声心动图测量的左心容积与非梗阻性肥厚型心肌病患者发生心房颤动(房颤)的关系。方法:连续性入选2023年1月到2024年1月在中国医学科学院阜外医院确诊的有完整临床资料和完整、清晰超声心动图影像资料的非梗阻性肥厚型心肌病患者85例,根据是否合并房颤分为合并房颤组(n=28)和未合并房颤组(n=57)。使用单心动周期实时全容积三维超声心动HeartModel自动测量技术测量左心容积指标包括左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、左心房容积(LAV),根据患者体表面积进行标化获得左心室舒张末期容积指数(LVEDVi)、左心室收缩末期容积指数(LVESVi)及左心房容积指数(LAVi),并常规测量其他超声心动图指标包括室间隔最厚处(IVSmax)厚度、左心室后壁(LVPW)厚度、左心房内径(LAD)等。综合二尖瓣前向血流频谱、组织多普勒、三尖瓣反流速度、左心房大小等对患者的左心室舒张功能进行评估,将舒张功能障碍分为Ⅰ级、Ⅱ级和Ⅲ级。采用多因素Logistic回归分析非梗阻性肥厚型心肌病患者发生房颤的影响因素。结果:合并房颤组的LVEDV[(117.1±21.9)ml vs.(143.8±26.7)ml]、LVEDVi[(64.2±10.6)ml/m2vs.(79.4±11.9)ml/m2]均小于未合并房颤组(P均<0.001),LAD[(48.6±4.8)mm vs.(40.2±4.7)mm]、LAVi[(64.4±17.1)ml/m2vs.(37.3±8.9)ml/m2]均大于未合并房颤组(P均<0.001);与未合并房颤组相比,合并房颤组的纽约心脏协会(NYHA)心功能分级≥Ⅲ级患者比例更高(15.8%vs.50.0%,P<0.001)、LVEF更低[(61.5±5.5)%vs.(57.6±5.0)%,P=0.002];合并房颤组的左心室舒张功能障碍更严重(P<0.001)。多因素Logistic回归分析显示,LVEDVi(OR=0.744,95%CI:0.575~0.962,P=0.024)和LAVi(OR=1.602,95%CI:1.032~2.486,P=0.036)是非梗阻性肥厚型心肌病患者发生房颤的影响因素。结论:LVEDVi和LAVi均是非梗阻性肥厚型心肌�Objectives:To analyze the risk factors of atrial fibrillation in patients with non-obstructive hypertrophic cardiomyopathy(NOHCM)and explore the relationship between left ventricular/atrial volume and atrial fibrillation.Methods:Consecutive NOHCM patients admitted at Fuwai Hospital from January 2023 to January 2024 with complete clinical data,satisfactory echocardiography imaging data were included in this analysis,patients were divided into atrial fibrillation group(n=28)and non-atrial fibrillation group(n=57).Left-sided volumetric and functional parameters were measured by onebeat real-time full-volume three-dimensional echocardiography,including left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),left atrial volume(LAV).The left ventricular end-diastolic volume(LVEDVi)index,left ventricular end-systolic volume index(LVESVi)and left atrial volume index(LAVi)were calculated.Other echocardiographic parameters including interventricular septum(IVSmax)thickness,left ventricular posterior wall thickness(LVPW),and left atrial diameter(LAD)were routinely measured.Mitral valve forward flow spectrum,tissue Doppler,tricuspid regurgitation velocity,and left atrial size were used to evaluate the left ventricular diastolic function of patients,and diastolic dysfunction was classified into grade I,II,and III.Multivariate logistic regression was used to analyze the influencing factors of atrial fibrillation in patients with non-obstructive hypertrophic cardiomyopathy Results:Compared with the non-atrial fibrillation group,LVEDV([143.8±26.7]ml vs.[117.1±21.9]ml)and LVEDVi([79.4±11.9]ml/m²vs.[64.2±10.6]ml/m²)were smaller in atrial fibrillation group(both P<0.001).Compared with the nonatrial fibrillation group,LAD([40.2±4.7]mm vs.[48.6±4.8]mm)and LAVi([37.3±8.9]ml/m²vs.[64.4±17.1]ml/m²)were lager in atrial fibrillation group(both P<0.001).Compared with the non-atrial fibrillation group,the proportion of NYHA functional classification≥Ⅲw

关 键 词：肥厚型心肌病 非梗阻性 心房颤动 左心室舒张末期容积指数 单心动周期实时全容积三维超声心动图 

分 类 号：R54[医药卫生—心血管疾病]