摘要
目的:探究射血分数保留心力衰竭(HFpEF)合并持续性心房颤动(PAF)患者超声测得左心房容积指数(LAVI)、左房内径(LAD)和N末端脑钠肽前体(NT-proBNP)变化及临床意义。方法:选取我院2019年7月—2022年5月收治的119例HFpEF合并PAF患者设为HFpEF合并PAF组,同期选取我院收治的50例HFpEF患者设为HFpEF组,根据HFpEF合并PAF组119患者术后3月心电图或者动态心电图复查结果将其分成2组,其中复发组共31例;未复发组共88例。超声测量LAVI、LAD,罗氏Cobas8000仪器检测血清NT-proBNP水平,比较2组资料及LAVI、LAD、NT-proBNP值,多因素Logistic回归模型研究HFpEF合并PAF复发的影响因素,采用Pearson检验进行相关性分析,受试者工作特征曲线评估LAVI、LAD、NT-proBNP值预测HFpEF合并PAF复发的效能。结果:与HFpEF组比较,HFpEF合并PAF组收缩压、舒张压、心率、应用钙拮抗剂占比以及LAVI、LAD、NT-proBNP值明显增高(P<0.05)。与未复发组比较,复发组收缩压、舒张压、心率、应用钙拮抗剂占比以及LAVI、LAD、NT-proBNP值明显增高(P<0.05)。Logistic回归多因素分析发现,收缩压降低为HFpEF合并PAF复发的保护因素(P<0.05),心率加快、舒张压增高、LAVI增高、LAD增大、NT-proBNP水平增高为HFpEF合并PAF复发的危险因素(P<0.05)。相关性分析数据结果提示,LAVI、LAD、NT-proBNP值分别与HFpEF合并PAF的复发呈正相关(r=0.681、0.633、0.725,P<0.001),LAVI、LAD分别与NT-proBNP值呈正相关(r=0.573、0.681,P<0.001)。3项指标联合应用时的预测效能(AUC=0.852)高于各指标单独应用及2项指标联合应用时,其预测灵敏度与特异度依次为70.97、97.73,临界点依次为38.43 mm、49.15 mL/m^(2)、1 686.58 pg/mL。结论:超声测量LAVI、LAD及NT-proBNP与HFpEF合并PAF复发关系密切,为HFpEF合并PAF复发影响因素,有望用于HFpEF合并PAF复发的临床辅助诊断,具备较高的灵敏度及特异度。
Objective:To explore the changes and clinical significance of left atrial volume index(LAVI)and left atrial diameter(LAD)measured by ultrasound and N-terminal pro-brain natriuretic peptide(NT-proBNP)in serum in patients with heart failure with preserved ejection fraction(HFpEF)and persistent atrial fibrillation(PAF).Methods:A total of 119 patients with HFpEF combined with PAF in our hospital from July 2019 to May 2022 were selected as the HFpEF combined with PAF group,and 50 patients with HFpEF in our hospital were selected as the HFpEF group at the same time.According to the results of ECG or Holter monitor examination 3 months after operation,119 patients in the HFpEF combined with PAF group were divided into two groups,including 31 cases in the recurrence group and 88 cases in the non recurrent group.LAVI and LAD were measured by ultrasound,and serum NT proBNP levels were measured using Roche Cobas8000 instrument,the values of data,LAVI,LAD,and NT proBNP between two groups were compared.The multivariate Logistic regression model was used to study the influencing factors of the recurrence of HFpEF combined with PAF.Pearson test was used for correlation analysis,and receiver operator characteristic curve was used to evaluate the efficacy of LAVI,LAD,and NT proBNP values in predicting the recurrence of HFpEF combined with PAF.Results:Compared with the HFpEF group,the HFpEF combined with PAF group showed significant increases in systolic blood pressure,diastolic blood pressure,heart rate,proportion of calcium antagonists used,LAVI,LAD,and NT proBNP values(P<0.05).Compared with the non recurrent group,the recurrent group showed significant increases in systolic blood pressure,diastolic blood pressure,heart rate,proportion of calcium antagonists used,LAVI,LAD,and NT proBNP values(P<0.05).The multivariate Logistic regression analysis found that decreased systolic blood pressure was a protective factor for the recurrence of HFpEF combined with PAF(P<0.05),while increased heart rate,diastolic blood pressure,LAVI,LAD,an
作者
赵恩晨
金仁波
宁伟
蒲瑜
党国珍
ZHAO En-chen;JIN Ren-bo;NING Wei;PU Yu;DANG Guo-zhen(Department of Ultrasound,Qinghai Cardiocerebrovascular Disease Hospital,Xining 810000,China)
出处
《中国临床医学影像杂志》
CAS
CSCD
北大核心
2024年第2期100-104,共5页
Journal of China Clinic Medical Imaging
基金
青海省科技计划项目(编号:2017-ZJ-754)。
关键词
心力衰竭
心房颤动
超声检查
多普勒
彩色
Heart Failure
Atrial Fibrllation
Ultrasonography,Doppler,Color
