CAJ | 학술논문

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。
목적：탐토좌심실서장공능장애적초성삼수，초성심동도서장조기이첨판혈류최대류속（E）여심방수축기이첨판혈류최대류속（A）적비치（E/A치）대심방전동（방전）도관소융복발적영향。 　　방법：회고성분석련속입원재삼유표측계통지도하수차행배폐정맥소융적환자277례。근거E/A치장연구인군분위삼조：①E/A치정상조（n=203례），0.75＜E/A치＜2（n=21례）；②E/A치경도이상조（n=53례），E/A치≤0.75；③E/A치중도이상조（n=21례），E/A치＞2，비교삼조간방전도관소융적만기복발솔。령안환자술후시부복발분위복발조（n=57례）여미복발조（n=220례）진행비교분석。복발조위소융3개월후발생지속30 s이상적방성쾌속성심률실상환자。 　　결과：제일부분회고성분석277례환자중，203례（73.2%）E/A치정상，53례（19.1%）경도이상，21례（7.6%）중도이상。평균수방91~970（374±276）천，57례（20.6%）만기복발，기중，E/A치중도이상조방전복발솔위33.3%，E/A치경도이상조위23.5%，균현저고우E/A치정상조（18.5%），단차이무통계학의의（P>0.05）。복발조E/A치위1.22±0.54략고우미복발조1.19±0.49，차이무통계학의의（P=0.653）。단인소분석，방전복발적예측인소포괄좌심실서장말경（LVEED）、성별，이E/A치불시방전만기복발적예측인소（P=0.236）。단장E/A치작위분류변량， Cox다인소회귀분석，경교정성별、고혈압、당뇨병、LVEDD、좌심실수축말경（LVESD），E/A치이상조시방전만기복발적예측인소（위험비2.29，95%가신구간1.01~5.19，P=0.046）。진일보교정LVEDD급E/A치지후，E/A치중도이상조잉연시방전복발적예측인소（위험비2.27，95%가신구간1.01~5.12，P=0.047）。 　　결론：E/A치시방전도관소융만기복발적중요예측인소。
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.