内皮功能对阵发性房颤患者心血管事件的影响

谭强; 郝佳; 陈明; 张兆前; 王丽娜

doi:10.12125/j.chj.202112030

内皮功能对阵发性房颤患者心血管事件的影响

Endothelial dysfunction predicts cardiovascular events in patients with paroxysmal atrial fibrillation

摘要

摘要:
目的旨在探讨阵发性房颤患者内皮功能受损与心血管事件的关系。
方法选择291例阵发性房颤患者为观察组，选择无房颤病史窦性心律者40例作为对照组。对观察组进行肱动脉血流介导的血管舒张功能（flow-mediated vasodilation，FMD）测定，并根据FMD水平将房颤患者分为低FMD房颤组（n=97，FMD<5.9 %）和高FMD房颤组（n=194，FMD≥5.9 %）。进行30个月的临床随访，首要终点事件定义为复合心血管事件（心血管死亡、非致死性心肌梗死、卒中和需住院的心力衰竭）。
结果低FMD房颤组平均年龄较对照组增高（P<0.05），也较高FMD房颤组增高（P<0.05）。低FMD房颤组CHA₂DS₂-VASc 积分较高FMD房颤组显著增加（P<0.05）。同时心脏超声数据显示低FMD房颤组左房末径值较对照组增高（P<0.01）、也较高FMD房颤组增高（P<0.05）；高FMD组左房末径值较对照组也明显升高（P<0.01）。与对照组比较，低FMD房颤组心血管事件发生率增加（P<0.01），高FMD房颤组亦增加（P<0.05）；与低FMD房颤组比较，高FMD房颤组的心血管事件发生率减少（P<0.05）；心血管事件发生率有统计学差异种类主要是心衰及卒中。Logistic多因素回归分析显示，低FMD值（OR=1.941，95%CI 1.005～3.748，P<0.05），CHA₂DS₂-VASc积分（OR=1.415，95%CI 1.024～1.956，P<0.05）以及LAD值（OR=1.055，95%CI 1.013～1.099，P ≤ 0.01）是预测阵发房颤患者心血管事件的独立危险因素。
结论阵发房颤患者内皮功能受损与心血管事件（尤其是心衰的发生）密切相关。

Abstract:
AIM To examine the relationship between endothelial dysfunction (measured by flow-mediated dilation, FMD) and cardiovascular events in patients with paroxysmal atrial fibrillation (AF).
METHODS In this prospective observational study, FMD of brachial artery was measured by ultrasound in 291 patients with paroxysmal AF and 40 patients with sinus arrhythmia. The AF patients were divided into low FMD group (n=97, FMD<5.9%) or high FMD group (n=194, FMD≥ 5.9%). The patients were followed up for at least 30 months and primary end point was cardiovascular events, including stroke, heart failure hospitalization, cardiovascular death and non-fatal myocardial infarction.
RESULTS The average age of low FMD atrial fibrillation group was higher than that of the control group (P<0.05), and it was also higher in high FMD atrial fibrillation group (P<0.05). The CHA₂DS₂ VASc score in low FMD atrial fibrillation group was significantly higher than that in FMD atrial fibrillation group (P<0.05). At the same time, cardiac ultrasound data showed that the value of left atrial end diameter in low FMD atrial fibrillation group was higher than that in control group (P<0.01), and it was also higher in high FMD atrial fibrillation group (P<0.05); The left atrial end diameter in the high FMD group was also significantly higher than that in the control group (P<0.01). Compared with the control group, the incidence of cardiovascular events increased in the low FMD atrial fibrillation group (P<0.01) and in the high FMD atrial fibrillation group (P<0.05); Compared with the low FMD AF group, the high FMD AF group had a lower incidence of cardiovascular events (P<0.05); There were significant differences in the incidence of cardiovascular events, mainly heart failure and stroke. Logistic multivariate regression analysis showed that low FMD value (OR=1.941, 95% CI 1.005～3.748, P<0.05), CHA₂DS₂ VASc score (OR=1.415, 95% CI 1.024～1.956, P<0.05) and LAD value (OR=1.055, 95% CI 1.013～1.099, P≤0.01) were independent risk factors for cardiovascular events in patients with paroxysmal atrial fibrillation.
CONCLUSION In patients with paroxysmal AF, endothelial dysfunction is associated with cardiovascular events, especially heart failure. FMD is a significant predictor of cardiovascular events independent of conventional cardiovascular risk in patients with paroxysmal AF.

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