Corbalán R, Arriagada D, Braun S, Tapia J, Huete I, Kramer A, Chávez A
Pontificia Universidad Católica de Chile, Department of Cardiovascular Diseases, Santiago.
Am Heart J. 1992 Jul;124(1):149-53. doi: 10.1016/0002-8703(92)90933-m.
The purpose of this study was to define the risk factors for systemic embolism in patients with recently diagnosed paroxysmal atrial fibrillation. We therefore studied 63 consecutive patients with symptomatic nonvalvular paroxysmal atrial fibrillation and performed a clinical and noninvasive cardiac, peripheral vascular, and neurologic evaluation that included two-dimensional echocardiography, 24-hour Holter monitoring, and computed tomographic brain scan. Patients with predisposing clinical conditions for systemic embolism (valvular heart or coronary artery disease) or paroxysmal atrial fibrillation (sick sinus disease, preexcitation, or thyroid dysfunction) were excluded. At entry 34 patients had idiopathic paroxysmal atrial fibrillation and 29 had hypertension. Fourteen patients had a recent systemic embolic complication: nine had a recent occlusive nonlacunar cerebrovascular accident, two had transient ischemic attacks, and three had peripheral systemic emboli that required surgery. In addition, five patients had evidence of old cerebrovascular accident on the computed tomographic scan (group 1). Forty-four patients had no systemic embolism (group 2). Results of univariate analysis showed that patients in group 1 were older (72 +/- 9 vs 63 +/- 13 years, p less than 0.05), had a higher incidence of hypertension (70% vs 35%, p less than 0.01), and had an increased left atrial diameter (4.1 +/- 0.7 vs 3.6 +/- 0.5 cm, p less than 0.05). Multiple stepwise logistic regression analysis showed that a history of hypertension and left atrial enlargement on two-dimensional echocardiography were significant independent risk factors for systemic embolism in patients with symptomatic nonvalvular paroxysmal atrial fibrillation.
本研究的目的是确定近期诊断为阵发性心房颤动患者发生系统性栓塞的危险因素。因此，我们研究了63例连续的有症状非瓣膜性阵发性心房颤动患者，并进行了临床及无创心脏、外周血管和神经系统评估，包括二维超声心动图、24小时动态心电图监测和计算机断层脑扫描。排除有系统性栓塞（瓣膜性心脏病或冠状动脉疾病）或阵发性心房颤动（病态窦房结综合征、预激或甲状腺功能障碍）的易感临床情况的患者。入组时，34例患者患有特发性阵发性心房颤动，29例患有高血压。14例患者近期发生系统性栓塞并发症：9例近期发生非腔隙性闭塞性脑血管意外，2例发生短暂性脑缺血发作，3例发生需要手术治疗的外周系统性栓塞。此外，5例患者在计算机断层扫描中有陈旧性脑血管意外证据（第1组）。44例患者无系统性栓塞（第2组）。单因素分析结果显示，第1组患者年龄较大（72±9岁 vs 63±13岁，p<0.05），高血压发生率较高（70% vs 35%，p<0.01），左心房直径增大（4.1±0.7 cm vs 3.6±0.5 cm，p<0.05）。多因素逐步逻辑回归分析显示，有症状非瓣膜性阵发性心房颤动患者中，高血压病史和二维超声心动图显示的左心房增大是系统性栓塞的重要独立危险因素。
