导管消融对合并有明显功能性二尖瓣反流的心房颤动患者临床转归的影响。
Effect of catheter ablation on clinical outcomes in patients with atrial fibrillation and significant functional mitral regurgitation.
机构信息
Department of Cardiology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
出版信息
BMC Cardiovasc Disord. 2021 Dec 7;21(1):587. doi: 10.1186/s12872-021-02397-5.
BACKGROUND
In patients with atrial fibrillation (AF) and functional mitral regurgitation (MR), catheter ablation reduces the severity of MR and improves cardiac remodeling. However, its effects on prognosis are uncertain.
METHODS
This retrospective study included 151 consecutive patients with AF and functional MR, 82 (54.3%) of whom were treated by catheter ablation (Ablation group) and 69 (45.7%) with drug therapy without ablation (Non-ablation group). Forty-three pairs of these patients were propensity matched on the basis of age, CHADS-VASc scores, and left ventricular ejection fraction. The primary outcome evaluated was severity of MR, cardiac remodeling and the combined incidence of subsequent heart failure-related hospitalization and strokes/transient ischemic attacks.
RESULTS
Patients in the Ablation group showed a significant decrease in the severity of MR (p < 0.001), a significant decrease in the left atrial diameter (p = 0.010), and significant improvement in the left ventricular ejection fraction (p = 0.015). However, patients in the Non-ablation group showed only a significant decrease in the severity of MR (p = 0.004). The annual incidence of the studied events was 4.9% in the Ablation group and 16.7% in the Non-ablation group, the incidence being significantly lower in the ablation than Non-ablation group (p = 0.026) according to Kaplan-Meier curve analyses. According to multivariate Cox regression analysis, catheter ablation therapy (hazard ratio [HR] 0.27, 95% confidence interval [CI] 0.09-0.84; p = 0.024) and heart failure at baseline (HR 3.84, 95% CI 1.07-13.74; p = 0.038) were independent predictors of the incidence of the studied events.
CONCLUSIONS
Among patients with AF and functional MR, catheter ablation was associated with a significantly lower combined risk of heart failure-related hospitalization and stroke than in a matched cohort of patients receiving drug therapy alone.
背景
在心房颤动（AF）合并功能性二尖瓣反流（MR）的患者中，导管消融可减轻 MR 的严重程度并改善心脏重构。然而，其对预后的影响尚不确定。
方法
这是一项回顾性研究，共纳入 151 例 AF 合并功能性 MR 的连续患者，其中 82 例（54.3%）接受导管消融（消融组）治疗，69 例（45.7%）接受无消融药物治疗（非消融组）。基于年龄、CHADS-VASc 评分和左心室射血分数，对这 43 对患者进行倾向评分匹配。主要结局评估为 MR 严重程度、心脏重构以及心力衰竭相关住院和卒中和/或短暂性脑缺血发作的复合发生率。
结果
消融组患者的 MR 严重程度显著降低（p<0.001），左心房直径显著减小（p=0.010），左心室射血分数显著提高（p=0.015）。然而，非消融组患者仅表现出 MR 严重程度的显著降低（p=0.004）。消融组的研究事件年发生率为 4.9%，非消融组为 16.7%，消融组明显低于非消融组（p=0.026），根据 Kaplan-Meier 曲线分析。多变量 Cox 回归分析显示，导管消融治疗（风险比 [HR] 0.27，95%置信区间 [CI] 0.09-0.84；p=0.024）和基线心力衰竭（HR 3.84，95%CI 1.07-13.74；p=0.038）是研究事件发生率的独立预测因素。
结论
在 AF 合并功能性 MR 的患者中，与单独接受药物治疗的匹配队列相比，导管消融与心力衰竭相关住院和卒中的综合风险显著降低相关。
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