CAJ | 학술논문

目的探讨心外膜脂肪组织(EAT)厚度在预测合并器质性瓣膜病变的永久性房颤患者双极射频消融术后房颤转归中的价值.方法 2012年1月至2013年1月,我们为184例患者进行瓣膜置换同期双极射频消融手术并成功复律,随访其纳入研究1年后房颤复发情况.结果 168例(占91.3％)患者完成末次随访.随访期内41例(占24.4％)患者复发房颤,其EAT厚度明显高于未复发房颤患者[(6.88±1.57) mm对(4.76±1.12) mm,P＜0.01].EAT厚度与患者年龄、体质量指数、左心房内径、二尖瓣与二尖瓣环舒张早期峰值速度比值、血浆中脂质水平呈正相关.Cox多因素分析发现,左心房内径(HR:1.15;95％ CI:1.06～ 1.23,P=0.02)、房颤病程(HR:1.05;95％ CI:1.00～ 1.08,P=0.04)和EAT厚度(HR:1.36;95％ CI:1.04～ 1.78,P=0.008)是患者术后房颤复发的独立危险因素,而房颤病程≥53.5个月、术前左心房内径≥56.5 mm和EAT厚度≥6.1 mm与患者术后房颤复发密切相关.结论应用经胸超声心动图测量EAT厚度可协同左心房内径大小准确评估合并器质性瓣膜病变的永久性房颤患者术后复发房颤的风险.
목적 탐토심외막지방조직(EAT)후도재예측합병기질성판막병변적영구성방전환자쌍겁사빈소융술후방전전귀중적개치.방법 2012년1월지2013년1월,아문위184례환자진행판막치환동기쌍겁사빈소융수술병성공복률,수방기납입연구1년후방전복발정황.결과 168례(점91.3％)환자완성말차수방.수방기내41례(점24.4％)환자복발방전,기EAT후도명현고우미복발방전환자[(6.88±1.57) mm대(4.76±1.12) mm,P＜0.01].EAT후도여환자년령、체질량지수、좌심방내경、이첨판여이첨판배서장조기봉치속도비치、혈장중지질수평정정상관.Cox다인소분석발현,좌심방내경(HR:1.15;95％ CI:1.06～ 1.23,P=0.02)、방전병정(HR:1.05;95％ CI:1.00～ 1.08,P=0.04)화EAT후도(HR:1.36;95％ CI:1.04～ 1.78,P=0.008)시환자술후방전복발적독립위험인소,이방전병정≥53.5개월、술전좌심방내경≥56.5 mm화EAT후도≥6.1 mm여환자술후방전복발밀절상관.결론 응용경흉초성심동도측량EAT후도가협동좌심방내경대소준학평고합병기질성판막병변적영구성방전환자술후복발방전적풍험.
Objective To investigate the predictive value of epicardial adipose tissue(EAT) thickness for the recurrence of atrial fibrillation (RAF) after concomitant valve replacement and bipolar radiofrequency ablation.Methods From January 2012 to January 2013,a total of 184 patients with permanent atrial fibrillation and organic valvular diseases underwent concomitant valve replacement and successful bipolar radiofrequency ablation.The patients were prospectively enrolled and were followed up for 12 months after the enrollment.Results One hundred and sixty-eight recruited patients(91.3％) completed a regular follow-up.During a 12-month follow-up period,RAF was observed in 41 patients(24.4％).Echocardiography-derived regional EAT thickness was significantly greater in RAF patients than that in non-RAF patients [(6.88 ± 1.57) mm vs.(4.76 ±1.12)mm,P ＜ 0.01].The EAT thickness strongly correlated with patients age,body mass index,E/e' ratio and the level of low-density lipoprotein and triglyceride.On Cox multivariable analysis,left atrial diameter(HR:1.15;95％ CI:1.06-1.23,P =0.02) 、duration of atrial fibrillation history (HR:1.05;95 ％ CI:1.00-1.08,P =0.04) and EAT thickness (HR:1.36;95％ CI:1.04-1.78,P =0.008) were independent predictors of RAF.The best cut-off values for the prediction were duration of atrial fibrillation history≥53.5 months、left atrial diameter≥56.5mm and EAT thickness ≥6.1 mm,the latter of which had an incremental predictive value for RAF.Conclusion A significant increase of EAT thickness provides independent information for predicting RAF after concomitant valve replacement and bipolar radiofrequency ablation.Echocardiography-derived regional EAT thickness combined with left atrial diameter may serve as effective parameters in identifying patients at the highest risk for RAF.