摘要
目的 分析老年慢性心力衰竭(心衰)合并心房颤动(房颤)患者的临床特点并探究其危险因素.方法 本研究是基于单次心衰患者住院资料的回顾性横断面研究.选取2020年1月至2021年12月武汉大学人民医院≥65岁的慢性心衰出院患者,收集患者本次住院期间的相关资料,根据是否合并房颤(房颤诊断均需要有心电图或者动态心电图证据)分为房颤组和窦性心律组,分析并比较人口信息学、合并症,血生化、心电图、超声心动图等检查指标,进行单因素逻辑回归寻找相关的危险因素和保护因素,最后根据单因素Logistic回归分析结果进行多因素Logistic分析并探究老年慢性心衰患者合并房颤的临床特征.结果 最终入选307例患者,年龄75(71,81)岁,其中男176例.房颤组143 例(143/307,46.58％),窦性心律组 164 例(164/307,53.42％).分析显示年龄≥75 岁(P=0.007)、合并高尿酸血症(P=0.017)、左心房内径增大(P=0.002)、右心房内径增大(P＜0.001)、LVEF≥50％(P＜0.001)、心率＞100次/min(P＜0.001)等与慢性心衰并发房颤风险呈显著正相关;而甘油三酯(OR=0.520,95％CI 0.334～0.811,P=0.004)与其呈负相关.结论 ≥65岁的慢性心衰患者中,≥75岁、合并高尿酸血症、左心房内径增大、右心房内径增大、LVEF≥50％、心率＞100次/min与合并房颤显著相关,且为独立危险因素,而高甘油三酯为独立保护因素.
Abstract
Objective To analyze the clinical characteristics of elderly patients with chronic heart failure(CHF)and atrial fibrillation(AF),and explore their risk factors.Methods This study was a retrospective cross-sectional analysis based on hospitalization data from patients with a single episode of CHF.The CHF patients aged ≥ 65 years in Renmin Hospital of Wuhan University between January 2020 and December 2021 were selected.Patient data were collected according to pre-defined inclusion and exclusion criteria,encompassing information related to their hospitalization period.Patients were divided into the sinus rhythm group and the AF group,based on the presence or absence of AF,with the diagnosis requiring electrocardiogram or ambulatory electrocardiogram evidence.Various clinical indicators were analyzed and compared between the two groups,including demographic information,comorbidities,biochemical markers,electrocardiogram,echocardiography and other indicators.Subsequently,univariate Logistic regression analysis was performed to identify potential risk factors and protective factors associated with the outcome of interest.Finally,multivariate Logistic regression analysis was conducted,taking into account the results of the univariate analysis,to further investigate the clinical characteristics of elderly patients with CHF and AF.Results A total of 307 patients were ultimately included in the study,with a median age of 75(IQR:71,81)years and 176 males,and the AF group with 143 patients(143/307,46.58％)and the sinus rhythm group with 164 patients(164/307,53.42％).Analysis revealed that age ≥75 years(P=0.007),hyperuricemia(P=0.017),left ventricular ejection fraction(LVEF)≥50％(P＜0.001),enlarged left atrial diameter(LAD,P=0.002),enlarged right atrial diameter(RAD,P＜0.001)and rapid heart rate＞100 bmp(P＜0.001)were significantly positively correlated with the risk of CHF and AF.In contrast,high triglyceride(TG)levels(OR=0.520,95％CI 0.334-0.811,P=0.004)were negatively correlated.Conclusion In conclusion,among CHF patients aged≥65 years,age ≥75 years,hyperuricemia,enlarged LAD,enlarged RAD,LVEF ≥50％and heart rate＞100 bpm were significantly associated with atrial fibrillation and identified as independent risk factors.Conversely,high TG levels emerged as an independent protective factor.
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