2021 年第 8 期 第 16 卷

左心室舒张功能障碍相关超声心动图参数对心房颤动导管消融术后复发的影响

Effect of left ventricular diastolic dysfunction related echocardiographic parameters on the recurrence of atrial fibrillation after catheter ablation

作者：刘冬玲1汤日波2王威仪1林新1樊泽元1李清艳1

英文作者：Liu Dongling1 Tang Ribo2 Wang Weiyi1 Lin Xin1 Fan Zeyuan1 Li Qingyan1

单位：1民航总医院心内科，北京100123；2首都医科大学附属北京安贞医院心内科100029

英文单位：1Department of Cardiology Civil Aviation General Hospital Beijing 100123 China; 2Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：心房颤动；导管消融术；舒张功能障碍；超声心动图 

英文关键词：Atrialfibrillation;Catheterablation;Diastolicdysfunction;Echocardiography

• 摘要：

• 目的 探讨左心室舒张功能障碍相关超声心动图参数对心房颤动导管消融术后复发的影响。方法 选取2017年11月至2020年5月于民航总医院就诊的阵发性心房颤动并首次行导管消融术的患者108例。所有患者入院后均行超声心动图检查，根据舒张早期二尖瓣最大血流速度（E峰）/二尖瓣环前壁、后壁、间隔及侧壁舒张早期血流速度的平均值（E′）比值将患者分为舒张功能障碍组（E/E′比值≥15，65例）和舒张功能正常组（E/E′比值＜15，43例）。比较2组入院基线资料、心房颤动术后早期及晚期复发率。分析心房颤动复发的预测因素。结果 舒张功能障碍组年龄、左心房内径均高于舒张功能正常组（均P＜0.001）。共28例患者出现心房颤动早期复发，舒张功能障碍组早期复发率与舒张功能正常组比较差异无统计学意义（P＞0.05）。早期复发组高血压、服用血管紧张素转换酶抑制剂（ACEI）/血管紧张素Ⅱ受体拮抗剂（ARB）比例高于早期未复发组［71.4%(20/28)比45.0%（36/80）、89.3%（25/28）比20.0%（16/80）］，服用他汀类药物比例低于早期未复发组［3.6%（1/28）比28.8%（23/80）］，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示他汀类药物是心房颤动早期复发的独立影响因素（比值比=0.061，95%置信区间：0.007~0.501，P=0.009）。Kaplan-Meier曲线分析结果显示舒张功能障碍组与舒张功能正常组术后心房颤动晚期复发率差异无统计学意义(Log-rank χ2=11.315，P=0.670)。多因素Cox回归分析结果显示，E/E′比值、ACEI/ARB、他汀类药物均不是心房颤动晚期复发的独立预测因素（均P＞0.05）。结论 E/E′比值不是心房颤动导管消融术后复发的预测因素，未服用他汀类药物可能增加心房颤动术后早期复发的风险。

• Objective To investigate the effect of left ventricular diastolic dysfunction related echocardiographic parameters on the recurrence of atrial fibrillation (AF) after catheter ablation. Methods From November 2017 to May 2020, 108 patients with AF underdoing first catheter ablation in Civil Aviation General Hospital were enrolled. All the patients were detected by echocardiography after admission. According to early diastolic mitral valve maximum flow velocity (E peak)/mean value of early diastolic blood velocities in the anterior, posterior, septal and lateral mitral annulus (E′) value, patients were divided into diastolic dysfunction group（E/E′ value≥15, 65 cases） and normal diastolic function group （E/E′ value＜15, 43 cases）. Basic data and  AF early and late postoperative recurrence rates were compared between the two groups. Predictors of AF recurrence were analyzed. Results The age and left atrial diameter in diastolic dysfunction group were higher than those in normal diastolic function group （both P＜0.001）. There were 28 cases of AF early recurrence and the difference in early recurrence rate between diastolic dysfunction group and normal diastolic function group was not statistically significant (P>0.05). The rates of hypertension and angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) in early recurrence group were higher than those in non-early recurrence group［71.4%(20/28) vs 45.0%（36/80）, 89.3%（25/28）vs 20.0%（16/80）］, and rate of statins in early recurrence group was lower than that in non-early recurrence group［3.6%（1/28）vs 28.8%（23/80）］(all P<0.05). Multivariate Logistic regression analysis showed that statins were independent influencing factors for AF early recurrence (odds ratio=0.061, 95% confidence interval: 0.007-0.501, P=0.009). Kaplan-Meier curve analysis showed that there was no significant difference in AF late recurrence between diastolic dysfunction group and normal diastolic function group (Log-rank χ2=11.315, P=0.670). Multivariate Cox regression analysis showed that E/E′ value, ACEI/ARB and statins were not independent predictors for AF late recurrence (all P>0.05). Conclusions E/E′ value is not an independent predictor for AF recurrence after catheter ablation. Not taking statins may increase the risk of early postoperative AF recurrence.