在接受左心耳封堵术的心房颤动患者中，肺动脉压与中期主要不良心血管事件及术后心包积液相关。
Pulmonary artery pressure is associated with mid-term major adverse cardiovascular events and postprocedure pericardial effusion in atrial fibrillation patients undergoing left atrial appendage occlusion.
作者信息
Zou Tian, Chen Qingxing, Zhang Lei, Chen Chaofeng, Ling Yunlong, Liu Guijian, Wang Sunying, Pang Yang, Xu Ye, Cheng Kuan, Zhou Daxin, Zhu Wenqing, Ge Junbo
机构信息
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China.
Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
出版信息
Ann Transl Med. 2021 Aug;9(16):1324. doi: 10.21037/atm-21-3561.
BACKGROUND
Patients with nonvalvular atrial fibrillation (NVAF) undergoing left atrial appendage occlusion (LAAO) are at high risk of stroke or bleeding. However, risk factors for their adverse cardiovascular events remain largely unknown. Pulmonary hypertension has been shown to be related to poor prognosis in many heart diseases. In this study, we determined whether elevated pulmonary artery systolic pressure (PASP) is associated with postprocedure adverse events and major adverse cardiovascular events (MACE) in these patients.
METHODS
From June 2017 and December 2019, 530 consecutive patients with NAVF at high risk of stroke or bleeding who undergone LAAO were retrospectively enrolled in our study. The preprocecure PASP was obtained by transthoracic echocardiography using the simplified Bernoulli's equation. Patients were followed-up through clinic visits or over the phone at discharge at 1-3 months, 6 months, and annually thereafter. The median follow-up time was 12 months, and clinical data were analyzed. MACE was defined as myocardial infarction, definite heart failure, stroke, or all-cause death. The outcome of postprocedure pericardial effusion included in-hospital pericardial effusion and pericardial effusion detected after discharge.
RESULTS
Univariate analyses indicated that patients who had MACE tended to have elevated PASP (P=0.005). After dividing the cohort according to the cut-off value of PASP, Kaplan-Meier curves indicated that patients with PASP ≥39.5 mmHg had a higher risk of MACE (P=0.007) and heart failure hospitalization (P=0.005) compared to patients whose PASP <39.5 mmHg. Cox regression analysis showed that PASP was a predominant risk factor of MACE (HR =2.337, 95% CI, 1.207-4.526, P=0.012) and heart failure hospitalization (HR =3.701, 95% CI, 1.118-12.251, P=0.032). Furthermore, the PASP cut-off added incremental discriminatory capacity to the MACE risk model of this cohort. In addition, logistic regression showed that PASP had as a significant association with postprocedure pericardial effusion (OR =1.061, P=0.032).
CONCLUSIONS
Elevated PASP was associated with postprocedure pericardial effusion and mid-term MACEs in patients with atrial fibrillation (AF) undergoing LAAO.
背景
接受左心耳封堵术（LAAO）的非瓣膜性心房颤动（NVAF）患者发生中风或出血的风险很高。然而，其不良心血管事件的危险因素在很大程度上仍不清楚。肺动脉高压已被证明与许多心脏病的不良预后有关。在本研究中，我们确定肺动脉收缩压（PASP）升高是否与这些患者术后不良事件和主要不良心血管事件（MACE）相关。
方法
从2017年6月至2019年12月，我们回顾性纳入了530例连续接受LAAO且有中风或出血高风险的NAVF患者。术前PASP通过经胸超声心动图使用简化的伯努利方程获得。患者在出院后1 - 3个月、6个月及之后每年通过门诊就诊或电话进行随访。中位随访时间为12个月，并对临床数据进行分析。MACE定义为心肌梗死、明确的心力衰竭、中风或全因死亡。术后心包积液的结果包括院内心包积液和出院后检测到的心包积液。
结果
单因素分析表明，发生MACE的患者往往PASP升高（P = 0.005）。根据PASP的临界值对队列进行划分后，Kaplan - Meier曲线表明，与PASP < 39.5 mmHg的患者相比，PASP≥39.5 mmHg的患者发生MACE（P = 0.007）和心力衰竭住院（P = 0.005）的风险更高。Cox回归分析显示，PASP是MACE（HR = 2.337，95%CI，1.207 - 4.526，P = 0.012）和心力衰竭住院（HR = 3.701，95%CI，1.118 - 12.251，P = 0.032）的主要危险因素。此外，PASP临界值为该队列的MACE风险模型增加了判别能力。此外，逻辑回归显示PASP与术后心包积液有显著关联（OR = 1.061，P = 0.032）。
结论
PASP升高与接受LAAO的心房颤动（AF）患者术后心包积液和中期MACE相关。
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