文章摘要

最小左房容积对非梗阻性肥厚型心肌病患者心血管事件的预测价值

作者: 1张复贵, 2陈龙菊, 1雷玉华
1 恩施土家族苗族自治州中心医院内科心血管病中心,湖北 恩施 445000
2 湖北民族大学医学院,湖北 恩施 445000
通讯: 雷玉华 Email: huayulei_0319@126.com
DOI: 10.3978/j.issn.2095-6959.2019.03.015
基金: 国家自然科学基金 (81260192)。

摘要

目的:探索最小左房容积( lef t atr ial minimal volume,L AVmin)预测非梗阻性肥厚型心肌病(hypertrophic cardiomyopathy,HCM)患者发生心血管事件的应用价值,并对最小(LAVmin)和最大左房容积(left atrial maximum volume,LAVmax)两个参数的预测价值进行比较。方法:共纳入167例非梗阻性HCM患者,年龄为(64.6±13.4)岁,男女比例为120:47。将患者相关临床资料和超声心动图相关参数进行统计分析,并随访记录患者发生不良心血管事件(心力衰竭住院、卒中、死亡)。将发生心血管事件的人群纳入观察组,剩余为对照组。结果:患者跟踪随访(25.0±17.7)个月,有35例发生了心血管不良事件,纳入观察组;观察组LAVmax,LAVmin均较对照组增加,差异有统计学意义,均P<0.001;多因素分析发现调整相关年龄,糖尿病,高血压,心房颤动等参数后LAVmin,LAVmax与心血管发生事件独立相关;受试者工作特征(receiver operating characteristic,ROC)曲线分析发现对非梗阻性HCM患者,LAVmin比LAVmax预测价值更大(曲线下面积分别为0.85和0.82,P=0.02)。 结论:LAVmin与非梗阻性HCM患者发生心血管事件独立相关,且其预测价值较LAVmax更好。
关键词: 最小左房容积;预测;非梗阻性肥厚型心肌病;心血管事件

Diagnostic value of left atrial minimal volume on cardiovascular events in patients with non-obstructive hypertrophic cardiomyopathy

Authors: 1ZHANG Fugui, 2CHEN Longju, 1LEI Yuhua
1 Medical Center of Internal Medicine, Enshi Tujia and Miao Autonomous Prefecture Central Hospital, Enshi Hubei 445000, China
2 Medical School, Hubei Minzu University, Enshi Hubei 445000, China

CorrespondingAuthor: LEI Yuhua Email: huayulei_0319@126.com

DOI: 10.3978/j.issn.2095-6959.2019.03.015

Foundation: This work was supported by the National Natural Science Foundation of China (81260192).

Abstract

Objective: To investigate the prognostic role of left atrial minimal volume (LAVmin) in patients with non-obstructive hypertrophic cardiomyopathy (HCM) and to test if LAVmin is better than left atrial maximum volume (LAVmax) in predicting clinical outcome. Methods: A total of 167 consecutive patients with non-obstructive HCM were enrolled [age (64.6±13.4) years, male:female = 120:47]. Patients had cardiovascular events (heart failure hospitalization, stroke, death) were also investigated. Clinical parameters and conventional echocardiographic measurement were measured. The relationship between LAVmin and the clinical outcome was evaluated. Results: During a median follow-up of (25.0±17.7) months, the cardiovascular events occurred in 35 patients (21%). And the 35 patients were placed in the observation group. LAVmax and LAVmin were higher in the observation group than the control group (all P<0.001). By means of multi-variable analysis, we found that LAVmin and LAVmax were predictive of cardiovascular events after adjustment for age, diabetes, hypertension, atrial fibrillation, LV ejection fraction, and E/e’ (P=0.001). By ROC analysis, we found that the model including indexed LAVmin was superior to the model including indexed LAVmax in predicting a worse outcome in patients with HCM (0.85 vs 0.82, P=0.02). Conclusion: LAVmin is independently associated with increased risk of HF, stroke, or mortality in patients with HCM and is superior to LAVmax in predicting clinical outcome in this population.
Keywords: left atrial minimal volume; prognosis; non-obstructive hypertrophic cardiomyopathy; cardiovascular events