Alpsoy Seref, Erselcan Kubilay, Akyuz Aydin, Gur Demet Ozkaramanli, Topuz Sahin, Topcu Birol, Guler Niyazi
Department of Cardiology, Namik Kemal University Faculty of Medicine, Tekirdag, Turkey.
Department Cardiology, Tekirdag State Hospital, Tekirdag, Turkey.
North Clin Istanb. 2019 Oct 8;7(1):18-24. doi: 10.14744/nci.2019.07078. eCollection 2020.
Our aim is to determine the triggering factors of paroxysmal atrial fibrillation (PAF) in ischemic heart failure (HF) patients with low ejection fraction (EF).
Sixty patients were included in this study. Echocardiography and 24-hours Holter monitoring were performed after measurement of serum NT-pro BNP concentration. The patients were classified into two groups concerning the occurrence of PAF on Holter recordings. Biochemical and echocardiographic parameters of patients with and without PAF were compared.
PAF was detected in 28 (46%) patients. Patients with PAF demonstrated higher NT-pro BNP levels, mitral and aortic regurgitation velocities, E/A, E/E', pulmonary capillary wedge pressure, pulmonary artery systolic pressure, left atrial volume and volume indices. NT-pro BNP was established as the predictor of PAF (OR=1.23, 95% CI: 1.08-1.42; p=0.001). ROC analysis showed an NT-pro BNP value of 2188 pg/mL as cut-off value with 68% sensitivity and 84% specificity [Area under the ROC curve (AUC)=0.826, CI 95%: 0.724-0.927; p<0.001].
The triggering factors for AF are increased intracardiac pressures, left atrial dilatation and increased wall tension. As an indicator of increased wall tension, elevated levels of NT-pro BNP predict the development of PAF.
我们的目的是确定射血分数（EF）较低的缺血性心力衰竭（HF）患者阵发性心房颤动（PAF）的触发因素。
本研究纳入60例患者。在测定血清N末端B型利钠肽原（NT-pro BNP）浓度后，进行超声心动图和24小时动态心电图监测。根据动态心电图记录中PAF的发生情况将患者分为两组。比较有PAF和无PAF患者的生化和超声心动图参数。
28例（46%）患者检测到PAF。有PAF的患者表现出更高的NT-pro BNP水平、二尖瓣和主动脉反流速度、E/A、E/E'、肺毛细血管楔压、肺动脉收缩压、左心房容积和容积指数。NT-pro BNP被确定为PAF的预测因子（比值比=1.23，95%置信区间：1.08-1.42；p=0.001）。ROC分析显示，NT-pro BNP值为2188 pg/mL作为截断值，敏感性为68%，特异性为84%[ROC曲线下面积（AUC）=0.826，95%置信区间：0.724-0.927；p<0.001]。
房颤的触发因素是心腔内压力升高、左心房扩张和壁张力增加。作为壁张力增加的指标，NT-pro BNP水平升高可预测PAF的发生。
