摘要
目的探讨动态心电图平均心室率对非阵发性心房颤动(AF)患者[合并和不合并冠状动脉粥样硬化性心脏病(冠心病)]全因死亡风险的影响。方法收集AF患者702例,排除阵发性AF、合并病态窦房结综合征、未行动态心电图检查的患者437例,最终纳入265例。依据动态心电图平均心室率水平分为A组(心室率≤80次/分)132例和B组(心室率>80次/分)133例。随访28(6~56)个月,采用倾向性评分匹配(PSM)分析控制混杂因素,然后对比动态心电图平均心室率与全因死亡关系。并依据患者是否合并冠心病分为冠心病AF组及非冠心病AF组,采用相同方法分析2组动态心电图平均心室率与全因死亡关系。结果PSM后,A组全因死亡率较B组低(OR=0.400,95%CI 0.166~0.962,P=0.041)。PSM后,冠心病AF组动态心电图平均心室率≤80次/分患者(A1组)全因死亡率与心室率>80次/分患者(B1组)比较差异无统计学意义(OR=0.730,95%CI 0.243~2.199,P=0.576);非冠心病AF组动态心电图平均心室率≤80次/分患者(A2组)的全因死亡率较心室率>80次/分患者(B2组)低(OR=0.282,95%CI 0.082~0.974,P=0.043)。结论非阵发性AF患者动态心电图平均心室率≤80次/分者全因死亡率较心室率>80次/分者低,但合并冠心病的AF患者未见以上预后关系。
Objective To investigate the relationship between mean ventricular heart rate of dynamic electrocardiogram and all-cause mortality in non-paroxysmal atrial fibrillation(AF)patients complicated with and without coronary artery disease.Methods Among 702 AF patients,437 cases who were diagnosed paroxysmal AF,complicated with sick sinus syndrome and failed to receive dynamic electrocardiogram were excluded.Finally,265 patients with non-paroxysmal AF were enrolled and divided into group A(mean heart rate≤80 b.p.m,n=132)and group B(mean heart rate>80 b.p.m,n=133)based on the mean heart rate of dynamic electrocardiogram.The median follow-up time was 28(6-56)months.The confounding factors were controlled by propensity score matching(PSM).The relationship between mean heart rate and all-cause mortality was analyzed.Patents were divided into the coronary artery disease(CAD)and non-CAD subgroups.The relationship between mean heart rate and all-cause mortality was also analyzed.Results The all-cause mortality in group A was significantly lower than that in group B(OR=0.400,95%CI 0.166-0.962,P=0.041).Among AF patients complicated with CAD,the all-cause mortality did not significantly differ between group A1 and group B1(OR=0.730,95%CI 0.243-2.199,P=0.576).Among AF patients without CAD,the all-cause mortality in group A2 was remarkably lower compared with that in group B2(OR=0.282,95%CI 0.082-0.974,P=0.043).Conclusion The mean heart rate of dynamic electrocardiogram of≤80 b.p.m predicts a lower all-cause mortality in non-paroxysmal AF patients that of>80 b.p.m.However,this prediction result can not be observed among AF patients complicated with CAD.
作者
陈泽锋
税星
汤磊乐
陈璘
Chen Zefeng;Shui Xing;Tang Leile;Chen Lin(Department of Cardiovascular Medicine,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)
出处
《新医学》
2020年第10期752-758,共7页
Journal of New Medicine
基金
广东省科技计划项目(2011B090400517)。
关键词
心房颤动
冠状动脉粥样硬化性心脏病
全因死亡
动态心电图平均心室率
倾向性评分匹配
Atrial fibrillation
Coronary artery disease
All-cause mortality
Mean ventricular heart rate of dynamic electrocardiogram
Propensity score matching
