[1]彭韵朴 谭震 刘磊 刘益均 任宏强.肥厚型心肌病合并心房颤动患者的心血管死亡和猝死风险评估[J].心血管病学进展,2024,(11):1051.[doi:10.16806/j.cnki.issn.1004-3934.2024.11.019]
　PENG Yunpu,TAN Zhen,LIU Lei,et al.The Risk Assessment of Cardiovascular Death and Sudden Death in Patients with Hypertrophic Cardiomyopathy Combined with Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2024,(11):1051.[doi:10.16806/j.cnki.issn.1004-3934.2024.11.019]
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肥厚型心肌病合并心房颤动患者的心血管死亡和猝死风险评估()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2024年11期
页码:
1051
栏目:
论著
出版日期:
2024-11-25

文章信息/Info

Title:
The Risk Assessment of Cardiovascular Death and Sudden Death in Patients with Hypertrophic Cardiomyopathy Combined with Atrial Fibrillation
作者:
彭韵朴 谭震 刘磊 刘益均 任宏强
(遂宁市中心医院心血管内科,四川 遂宁 629000)
Author(s):
PENG Yunpu; TAN Zhen; LIU Lei; LIU Yijun; REN Hongqiang
(Department of Cardiovascular,Suining Central Hospital,Suining 629000,Sichuan,China)
关键词:
肥厚型心肌病; 心房颤动; 心血管死亡; 猝死
Keywords:
Hypertrophic cardiomyopathy; Atrial fibrillation; Cardiovascular death; Sudden death
DOI:
10.16806/j.cnki.issn.1004-3934.2024.11.019
摘要:
目的 该研究旨在评估肥厚型心肌病合并心房颤动（房颤）患者的心血管死亡及猝死风险。方法 本研究是一项回顾性研究，纳入2016年3月—2023年6月在遂宁市中心医院诊断肥厚型心肌病（HCM）患者298例，记录患者一般资料及相关检查结果，采用电话或门诊随访，随访至2023年12月。采用Kaplan-Meier生存曲线分析法，基于log-rank检验比较无房颤HCM患者与HCM合并房颤患者心血管死亡和猝死风险的差异。建立多因素Cox比例风险模型评估房颤与HCM患者心血管死亡和猝死的相关性。进一步采用竞争风险模型作为敏感性分析。结果 无房颤HCM患者252例，HCM合并房颤患者46例。房颤组患者的心功能分级较无房颤组患者差（P＜0.001），而房颤组患者QT间期较无房颤组患者缩短（P＜0.001），其LAD大于无房颤组患者（P＜0.001）。Kaplan-Meier分析HCM合并房颤患者心血管死亡及猝死的累积发生率，结果提示房颤组患者心血管死亡及猝死风险均高于无房颤组患者（log-rank P=0.000 17，log-rank P=0.017）。多变量Cox回归分析提示房颤与HCM患者心血管死亡和猝死相关（HR=2.846，95% CI 1.466～5.524，P=0.002；HR=3.829，95% CI 1.191～12.311，P=0.024）。竞争风险分析中Gray’s检验提示HCM合并房颤患者的猝死及竞争事件累积发生率较无房颤组患者更高（P=0.038，P=0.006）。将房颤、年龄、性别、体重指数、纽约心功能分级、左室射血分数、室性心动过速、左心室壁最大厚度、流出道梗阻纳入多变量竞争风险分析提示房颤是HCM患者猝死的独立危险因素（HR=3.487，95% CI 1.002～12.152，P=0.046）。结论 房颤与HCM患者心血管死亡和猝死相关，是HCM患者猝死的独立危险因素。
Abstract:
Objective To investigate the risk of cardiovascular death and sudden death in patients with hypertrophic cardiomyopathy (HCM) combined with atrial fibrillation (AF). Methods This study is a retrospective study. 298 patients with HCM diagnosed at the Suining Central Hospital from March 2016 to June 2023 were enrolled. Baseline data and examination results were collected for these patients. Follow-ups were conducted via phone or outpatient visit until December 2023. The survival curve was plotted using the Kaplan-Meier method,and the differences in risk of cardiovascular death and sudden death were compared based on the log-rank test. Multivariate Cox proportional risk model was established to evaluate the association between AF and cardiovascular death and sudden death in patients with HCM. The competitive risk model was further used for sensitivity analysis. Results There were 252 HCM patients without AF and 46 HCM patients with AF. The New York Heart function assessment of patients in AF group was significantly poorer than that in non-AF group (P < 0.001). Additionally,the QT interval in AF group was shorter compared to that in non-AF group (P < 0.001),and the left atrial diameter was greater than that in non-AF group (P < 0.001). Kaplan-Meier analysis of the cumulative incidence of cardiovascular death and sudden death in patients with HCM combined with AF showed that the risk of cardiovascular death and sudden death in patients with AF was higher than that in patients without AF (log-rank P=0.000 17,log-rank P=0.017). Multivariate Cox regression analysis suggested that AF was associated with cardiovascular death and sudden death in HCM patients (HR=2.846,95% CI 1.466～5.524,P=0.002; HR=3.829,95% CI 1.191～12.311,P=0.024). In the competitive risk analysis,Gray’s test indicated that the risk of sudden death and the cumulative incidence of competitive events in AF HCM group was higher than that in the non-AF HCM group (P=0.038,P=0.006). AF,age,sex,body mass index,New York heart function assessment,left ventricular ejection fraction,ventricular tachycardia,left ventricular maximum wall thickness,and outflow tract obstruction were included in multivariate competitive risk analysis,suggesting that AF was an independent risk factor for sudden death in patients with HCM (HR=3.487,95% CI 1.002～12.152,P=0.046). Conclusions AF is not only associated with cardiovascular death and sudden death,but also an independent risk factor for sudden death in HCM patient

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更新日期/Last Update: 2024-12-02