摘要
目的：探讨左心室舒张功能障碍的超声参数，超声心动图舒张早期二尖瓣血流最大流速（E）与心房收缩期二尖瓣血流最大流速（A）的比值（E/A值）对心房颤动（房颤）导管消融复发的影响。 方法：回顾性分析连续入院在三维标测系统指导下首次行环肺静脉消融的患者277例。根据E/A值将研究人群分为三组：①E/A值正常组（n=203例），0.75＜E/A值＜2（n=21例）；②E/A值轻度异常组（n=53例），E/A值≤0.75；③E/A值重度异常组（n=21例），E/A值＞2，比较三组间房颤导管消融的晚期复发率。另按患者术后是否复发分为复发组（n=57例）与未复发组（n=220例）进行比较分析。复发组为消融3个月后发生持续30 s以上的房性快速性心律失常患者。 结果：第一部分回顾性分析277例患者中，203例（73.2%）E/A值正常，53例（19.1%）轻度异常，21例（7.6%）重度异常。平均随访91~970（374±276）天，57例（20.6%）晚期复发，其中，E/A值重度异常组房颤复发率为33.3%，E/A值轻度异常组为23.5%，均显著高于E/A值正常组（18.5%），但差异无统计学意义（P〉0.05）。复发组E/A值为1.22±0.54略高于未复发组1.19±0.49，差异无统计学意义（P=0.653）。单因素分析，房颤复发的预测因素包括左心室舒张末径（LVEED）、性别，而E/A值不是房颤晚期复发的预测因素（P=0.236）。但将E/A值作为分类变量， Cox多因素回归分析，经校正性别、高血压、糖尿病、LVEDD、左心室收缩末径（LVESD），E/A值异常组是房颤晚期复发的预测因素（危险比2.29，95%可信区间1.01~5.19，P=0.046）。进一步校正LVEDD及E/A值之后，E/A值重度异常组仍然是房颤复发的预测因素（危险比2.27，95%可信区间1.01~5.12，P=0.047）。 结论：E/A值是房颤导管消融晚期复发的重要预测因素。
Objective： To explore the impact of echocardiographic parameter of diastolic dysfunction （E/A） on the recurrence of atrial ifbrillation （AF） in patients after catheter ablation. Methods： We retrospectively studied 277 consecutive AF patients with circumferential pulmonary vein ablation （CPVA） in our hospital. According to E/A ratio, the patients were divided into 3 groups： Normal group, the patients with 0.75〈 E/A〈2, n=203, Mild abnormal group, E/A≤0.75, n=53 and Severe abnormal group, E/A〉2, n=21. The late AF recurrent rates were compared among different groups. The patients were divided into another 2 groups upon AF recurrence after CPVA： Recurrent group, n=57 patients with atrial arrhythmia lasted more than 30 seconds at 3 months after CPVA and Non-recurrent group, n=220. The clinical conditions were compared between 2 groups. Results： The patients were followed-up for （374 ± 276） days. The AF recurrent rate in Severe abnormal group was 33.3%, in Mild abnormal group was 23.5% and in Normal group was 18.5%, P〉0.05. The E/A ratio in Recurrent group was 1.22 ± 0.54, in Non-recurrent group was 1.19 ± 0.49, P=0.653. Univariate analysis indicated that the risk factors for AF recurrence included LVEDD and gender, not E/A ratio （P=0.236）. Cox multivariate analysis indicated that with adjusted gender, hypertension, diabetes, LVEDD and LVESD, abnormal E/A ratio was the predictor for late AF recurrence （HR 2.29, 95%CI 1.01-5.19, P=0.046）. With further adjusted LVEDD and E/A, the severe abnormal E/A ratio was still the predictor for AF recurrence （HR 2.27, 95%CI 1.01-5.12, P=0.047）. Conclusion： E/A ratio was the important predictor for AF recurrence in patients after CPVA.
出处
《中国循环杂志》
CSCD
北大核心
2014年第8期615-619,共5页
Chinese Circulation Journal
关键词
E
A值
心房颤动
导管消融
复发
E/A ratio Atrial ifbrillation Catheter ablation Recurrence
