Nie Changrong, Zhu Changsheng, Xiao Minghu, Lu Zhengyang, Yang Qiulan, Meng Yanhai, Wu Rong, Wang Shuiyun
Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China.
Department of Ultrasound, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China.
Front Cardiovasc Med. 2021 Jul 7;8:666431. doi: 10.3389/fcvm.2021.666431. eCollection 2021.
Pulmonary arterial hypertension (PH) is a common complication in patients with obstructive hypertrophic cardiomyopathy (OHCM). The risk factor of PH in patients with OHCM has not been fully elucidated, and even atrial fibrillation (AF) was considered a risk factor of PH. Thus, our study aimed to investigate risk factors of PH and the relationship between PH and AF in patients with OHCM. We retrospectively enrolled 483 consecutive patients diagnosed with OHCM at Fuwai Hospital (Beijing, China) from January 2015 to December 2017. Clinical and echocardiographic parameters were compared between patients with and without PH. Eighty-two (17.0%) patients were diagnosed with PH in this study. Compared to patients without PH, those with PH were significantly older, had a lower body mass index (BMI), were more likely to be female and more symptomatic [New York Heart Association Class 3 or 4 symptoms], and had a higher AF prevalence. A multivariate analysis indicated that AF was an independent risk factor of PH (odds ratio [OR] 2.31, 95% confidence interval [CI] 1.03-5.20, p = 0.042). Moreover, PH was independently associated with a higher AF incidence after adjusting for age and left atrial diameter (OR 2.24, 95% CI 1.07-4.72, p = 0.034). AF was independently associated with PH in patients with OHCM. Further, PH was significantly associated with an increased risk of AF, which suggested that AF could aggravate PH and that PH may promote AF processes, forming a vicious circle.
肺动脉高压（PH）是梗阻性肥厚型心肌病（OHCM）患者的常见并发症。OHCM患者发生PH的危险因素尚未完全阐明，甚至心房颤动（AF）曾被认为是PH的危险因素。因此，我们的研究旨在调查OHCM患者发生PH的危险因素以及PH与AF之间的关系。我们回顾性纳入了2015年1月至2017年12月期间在中国医学科学院阜外医院（北京）连续诊断为OHCM的483例患者。比较了有PH和无PH患者的临床和超声心动图参数。本研究中82例（17.0%）患者被诊断为PH。与无PH的患者相比，有PH的患者年龄显著更大，体重指数（BMI）更低，更可能为女性且症状更明显[纽约心脏协会3或4级症状]，AF患病率更高。多因素分析表明AF是PH的独立危险因素（比值比[OR]2.31，95%置信区间[CI]1.03 - 5.20，p = 0.042）。此外，在调整年龄和左心房直径后，PH与更高的AF发生率独立相关（OR 2.24，95% CI 1.07 - 4.72，p = 0.034）。AF与OHCM患者的PH独立相关。此外，PH与AF风险增加显著相关，这表明AF可能加重PH，且PH可能促进AF进展，形成恶性循环。
