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目的探讨临床评价慢性房颤患者的心功能全面、客观、量化指标。方法选择2007年1～7月苏州大学附属第一医院心内科慢性房颤患者75例(慢性房颤组)和门诊正常体检者20名(对照组)。所有入选者均采用我院心超室制订的综合超声心动图多项参数的心力衰竭超声指数进行评分,并将该评分、左心室射血分数(LVEF)、同期血浆脑钠肽(BNP)检测结果及纽约心功能分级进行比较。结果心力衰竭超声指数在慢性房颤组高于对照组(P<0.01),且随着纽约心功能分级的升高而升高,心功能I、Ⅱ、Ⅲ、Ⅳ级的慢性房颤患者的心力衰竭超声指数分别为1.47±0.92、2.53±1.06、3.68±1.19、4.82±1.24。Spearman相关性分析表明,心力衰竭超声指数与血浆BNP高度相关(r=0.86,P<0.01),与纽约心功能分级也呈高度相关(r=0.87,P<0.01);同期的LVEF与血浆BNP值呈负相关(r=-0.53,P<0.01),与纽约心功能分级也呈负相关(r=-0.49,P<0.01),其相关程度均显著低于心力衰竭超声指数与BNP及纽约心功能分级的相关性。结论心力衰竭超声指数作为评价慢性房颤患者心功能要比单一的LVEF更准确,值得临床推广应用。
Objective To investigate the clinical evaluation of patients with chronic atrial fibrillation comprehensive, objective and quantitative indicators. Methods From January 2007 to July 2007, 75 patients with chronic atrial fibrillation in the First Affiliated Hospital of Soochow University (Chronic atrial fibrillation group) and 20 normal subjects (control group) were selected. All the participants were scored by using the echocardiographic parameters of heart failure developed by our hospital. The scores of left ventricular ejection fraction (LVEF), plasma BNP Results and New York Heart Function grading were compared. Results The index of heart failure in chronic atrial fibrillation group was higher than that in control group (P <0.01), and increased with the increase of NYC functional class. The cardiac function in patients with chronic atrial fibrillation of grade I, II, III and IV Heart failure ultrasound index was 1.47 ± 0.92,2.53 ± 1.06,3.68 ± 1.19,4.82 ± 1.24. Spearman correlation analysis showed that the index of heart failure was highly correlated with plasma BNP (r = 0.86, P <0.01), and was also highly correlated with New York Heart Association (r = 0.87, P <0.01) (R = -0.53, P <0.01), and also had a negative correlation with New York Heart Association (r = -0.49, P <0.01), the correlation was significantly lower than that of heart failure with BNP and New York Correlation of heart function grading. Conclusions The heart failure ultrasound index is more accurate than the single LVEF in evaluating the cardiac function in patients with chronic atrial fibrillation, which is worthy of clinical application.