心血管植入式电子器械与三尖瓣反流加重的影响因素

Influencing factors for tricuspid regurgitation after implantation of cardiovascular implantable electronic devices

摘要:

目的 探讨心血管植入式电子器械(CIEDs)患者三尖瓣反流加重的影响因素及可能的发生机制。方法 回顾性收集解放军总医院第一医学中心心血管内科2014年1月至2016年12月所有植入CIEDs(单腔或双腔永久式起搏器、埋藏式心律转复除颤器及心脏再同步化治疗)后复查心脏彩超的198例患者的临床资料。根据术后三尖瓣反流是否加重分为三尖瓣反流未加重组146例和加重组52例,比较2组患者的临床资料及术前心脏彩超资料。采用SPSS 17.0软件对数据进行统计学处理。组间比较采用Mann-Whitney U检验、非配对χ²检验或Fisher精确概率法。采用多因素logistic逐步回归法分析三尖瓣反流加重的相关危险因素。结果 与未加重组比较,加重组患者男性、术前肌酐清除率、高脂血症及植入时间＞12个月的的患者比例升高,术前右心房内径较小、二尖瓣及三尖瓣存在反流的患者比例较低,差异有统计学意义(P<0.05)。多因素logistic回归分析表明,植入时间(OR=1.000,95%CI 1.001~1.003;P=0.013)和高脂血症(OR=2.024,95%CI 6.728~22.360; P=0.022)可能是三尖瓣反流加重的独立危险因素；术前存在轻度三尖瓣反流(OR=0.018,95%CI 0.049~0.133; P<0.001)可能是三尖瓣反流加重的独立保护因素。结论 起搏器植入时间、高脂血症可加重三尖瓣反流,术前三尖瓣反流程度与术后三尖瓣反流加重相关,应注意随访观察。

Abstract:

Objective To explore the influencing factors for greater tricuspid regurgitation after the implantation of cardiovascular implantable electronic devices (CIEDs), and investigate its possible mechanism. Methods Clinical data of 198 patients who undergoing implantation of CIEDs (including single- or dual-chamber permanent pacemakers, embedded cardioverter-defibrillators and cardiac resynchronisation therapy) in our department from January 2014 to December 2016 were collected in this study. According to the changes of tricuspid regurgitation observed by echocardiography before and after implantation, the selected patients were divided into unaggravated tricuspid regurgitation group (n=146) and aggravated tricuspid regurgitation group (n=52). Clinical data and preoperative echocardiographic data were compared between the 2 groups. SPSS statistics 17.0 was used to perform the statistical analysis. Mann-Whitney U test, unpaired Chi-square test or Fisher exact probability test was employed for comparison between groups. Multivariate logistic stepwise regression was applied to analyze the risk factors for tricuspid regurgitation. Results Compared with the unaggravated group, the proportions of male, preoperative creatinine clearance rate, hyperlipidemia and implantation time >12 months were significantly higher, while the proportions of smaller preoperative right atrial diameter and mitral and tricuspid regurgitation were obvious lower in the aggravated group (P<0.05). Multiple logistic regression analysis showed that implantation time (OR=1.000,5%CI 1.001-1.003; P=0.013) and hyperlipidemia (OR=2.024,5%CI 6.728-22.360; P=0.022) were independent risk factors for aggravation of tricuspid regurgitation, and mild tricuspid regurgitation before CIED implantation ( OR=0.018,5%CI 0.049-0.133; P<0.001) was independent protective factor for the aggravation. Conclusion CIED implantation time and hyperlipidemia can aggravate tricuspid regurgitation, and the severity of tricuspid regurgitation before operation is correlated with the aggravation after implantation. Attention should be paid to follow-up observation.