心房颤动对心脏再同步化治疗患者临床预后的影响

发布时间：2019-02-19 15:33

【摘要】：目的:探讨心脏再同步化治疗(CRT)患者合并心房颤动(房颤)的临床特征,并分析房颤对CRT患者临床预后的影响。方法:回顾性收集2010-01至2014-12于阜外医院心律失常中心接受首次CRT植入的258例患者临床资料,根据患者是否合并房颤分为房颤组和无房颤组。定义随访终点为心力衰竭再住院和全因死亡(包括心脏移植)。采用Kaplan-Meier法绘制生存曲线,log-rank检验比较两组的临床预后,采用单因素和多因素Cox比例风险回归模型分析房颤对CRT植入患者临床终点的预测作用。结果:基线数据显示,42例(16.3%)患者合并阵发性房颤,房颤组患者年龄、男性比例、左束支传导阻滞(LBBB)比例、估计肾小球滤过率(e GFR)、血肌酐、血尿酸、大内皮素、超声左心房直径、胺碘酮使用比例与非房颤组患者相比差异具有统计学意义。经过中位随访时间22个月随访,死亡33例(12.8%),心脏移植5例(1.9%),心力衰竭再住院72例(27.9%)。生存分析显示,房颤组患者心力衰竭再入院率显著高于无房颤组(χ~2=6.651,P=0.010),全因死亡率与无房颤组比较差异无统计学意义(χ~2=0.528,P=0.468)。Cox单因素分析显示:房颤、非LBBB、血肌酐高、大内皮素高、左心房大为心力衰竭再住院可疑危险因素;血肌酐高、大内皮素高、左心房大为全因死亡可疑危险因素。Cox多因素分析显示:房颤不是心力衰竭再住院和全因死亡的独立危险因素;但左心房大[HR=1.041,95%可信区间(CI):1.007~1.075,P=0.018]是心力衰竭再住院的独立危险因素,左心房大(HR=1.045,95%CI:1.001~1.091,P=0.048)和血肌酐高(HR=1.008,95%CI:1.001~1.015,P=0.035)是全因死亡的独立危险因素。结论 :合并房颤的CRT患者心力衰竭再住院率增加,尚无确切证据支持房颤是合并房颤的CRT患者心衰再住院和全因死亡的独立危险因素。
[Abstract]:Objective: to investigate the clinical features of cardiac resynchronization in patients with (CRT) complicated with atrial fibrillation (AF) and to analyze the influence of AF on the clinical prognosis of CRT patients. Methods: the clinical data of 258 patients who received the first CRT implantation from January 2010 to December 2014-12 in the Arrhythmia Center of Fuwei Hospital were retrospectively collected. The patients were divided into AF group and non-AF group according to whether the patients were complicated with AF. Rehospitalization and all-cause death (including heart transplantation) were defined as the end point of follow-up. Kaplan-Meier method was used to draw survival curve, log-rank test was used to compare the clinical prognosis of the two groups, and univariate and multivariate Cox proportional risk regression models were used to analyze the predictive effect of atrial fibrillation on clinical endpoints in patients with CRT implantation. Results: baseline data showed that 42 patients (16.3%) were associated with paroxysmal atrial fibrillation. Age, male ratio, (LBBB) ratio of left bundle branch block, estimated glomerular filtration rate (e GFR), serum creatinine and uric acid were estimated. Large endothelin, left atrial diameter and amiodarone use ratio were significantly different from those in non-atrial fibrillation group. After a median follow-up of 22 months, 33 cases (12.8%) died, 5 cases (1.9%) received heart transplantation and 72 cases (27.9%) were hospitalized with heart failure. Survival analysis showed that the readmission rate of heart failure in the AF group was significantly higher than that in the non-AF group (蠂 ~ 2 ~ 2 6.651g / P ~ (0.010), and there was no significant difference in the total cause mortality between the two groups (蠂 ~ 2 ~ 2 ~ 0. 528). Univariate analysis at 0.468). Cox showed that atrial fibrillation, high serum creatinine in non-LBBB, high large endothelin and suspicious risk factors in patients with heart failure in left atrium were suspected. Cox multivariate analysis showed that atrial fibrillation was not an independent risk factor for rehospitalization of heart failure and all-cause death. But large left atrium [HR=1.041,95% confidence interval (CI): 1.007 + 1.075% P0.018] was an independent risk factor for rehospitalization of heart failure, and left atrial large (HR=1.045,95%CI:1.001~1.091,) was a risk factor for rehospitalization of heart failure. High serum creatinine (HR=1.008,95%CI:1.001~1.015,P=0.035) is an independent risk factor for all death. Conclusion: the rehospitalization rate of heart failure in CRT patients with atrial fibrillation is increased, and there is no clear evidence that AF is an independent risk factor for heart failure readmission and all-cause death in CRT patients with atrial fibrillation.
【作者单位】：北京协和医学院中国医学科学院国家心血管病中心阜外医院心血管疾病国家重点实验室;
【分类号】：R541.75

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