永久性孤立性心房颤动与房室瓣反流：前者会导致后者吗？

Permanent lone atrial fibrillation and atrioventricular valve regurgitation: may the former lead to the latter?

作者信息

Oren Michal, Oren Ohad, Feldman Alexander, Bloch Lev, Turgeman Yoav

出版信息

J Heart Valve Dis. 2014 Nov;23(6):759-64.

Abstract

BACKGROUND AND AIM OF THE STUDY

Atrioventricular valve regurgitation (AVVR) has been described in patients with long-standing atrial fibrillation (AF) despite normal valve anatomy and leaflet mobility. The study aim was to examine the association between permanent lone AF and AVVR.

METHODS

A total of 47 patients with lone AF was studied. Patients provided information regarding the time since onset of arrhythmia, and mitral regurgitation (MR) and tricuspid regurgitation (TR) were graded using color-mapping Doppler echocardiography. AVVR was defined as any degree of valve regurgitation. Annular diameters (in mm) and atrial areas (in cm2) were measured at enddiastole, using digital analysis.

RESULTS

Of the 47 patients, 19 (40%) had paroxysmal AF and 28 (60%) had permanent AF. Mild MR was present in nine of 19 patients (47%) with paroxysmal AF and in 15 of 28 (53%) with permanent AF (p = 0.68). Mild TR was identified in nine (47%) patients with paroxysmal AF, and in 16 (58%) of those with permanent AF (p = 0.08). None of the patients with paroxysmal AF had either moderate or severe AVVR. In 28 patients with permanent lone AF, significant MR and TR were detected in six (21%) and five (19%) patients, respectively. Patients with permanent lone AF had a 6.5-fold higher likelihood of having TR (p = 0.0031) and were marginally more likely to have MR (p = 0.053) compared to those with paroxysmal AF. Relative to patients with paroxysmal AF, those with permanent AF had larger atrial areas and annular diameters, while patients with TR had higher atrial areas and mitral annular diameters than those without. The mean follow up of patients with permanent AF and significant AVVR was 54 + 13 months, compared to 13 +/- 7 months for those without significant AVVR (p = 0.002).

CONCLUSION

Permanent lone AF is associated with TR and, less strongly, with MR. Atrial size and mitral annular diameter are increased in patients with lone AF who have TR.

摘要

研究背景与目的

尽管房室瓣解剖结构及瓣叶活动正常，但长期心房颤动（AF）患者中已出现房室瓣反流（AVVR）的描述。本研究目的是探讨永久性孤立性AF与AVVR之间的关联。

方法

共研究47例孤立性AF患者。患者提供心律失常发作以来的时间信息，采用彩色多普勒超声心动图对二尖瓣反流（MR）和三尖瓣反流（TR）进行分级。AVVR定义为任何程度的瓣膜反流。使用数字分析在舒张末期测量瓣环直径（单位：mm）和心房面积（单位：cm²）。

结果

47例患者中，19例（40%）为阵发性AF，28例（60%）为永久性AF。19例阵发性AF患者中有9例（47%）存在轻度MR，28例永久性AF患者中有15例（53%）存在轻度MR（p = 0.68）。9例（47%）阵发性AF患者及16例（58%）永久性AF患者中发现轻度TR（p = 0.08）。阵发性AF患者中无中度或重度AVVR。在28例永久性孤立性AF患者中，分别有6例（21%）和5例（19%）检测到显著MR和TR。与阵发性AF患者相比，永久性孤立性AF患者发生TR的可能性高6.5倍（p = 0.0031），发生MR的可能性略高（p = 0.053）。与阵发性AF患者相比，永久性AF患者的心房面积和瓣环直径更大，而有TR的患者比没有TR的患者心房面积和二尖瓣瓣环直径更高。永久性AF和显著AVVR患者的平均随访时间为54 ± 13个月，无显著AVVR患者为13 ± 7个月（p = 0.002）。