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目的探讨心房电-机械检测(Pd、Pmax、LAD)和心脏神经内分泌激素BNP水平与阵发性房颤(PAF)相关性及对PAF的预测价值。方法选择130例阵发房颤患者,及92例无房颤者为对照组,分别测定两组P波离散度(Pd),P波最大时限(Pmax),测量左房最大内径(LAD)及监测血液脑钠肽(BNP)水平,随访1～3年,观察两组患者房颤发作情况。结果有PAF患者Pd(p<0.001),Pmax(p<0.001),LA(p<0.05),BNP(p>0.05)大于无PAF患者;单变量分析显示LAD、Pmax、Pd为阵发性心房颤动的预测因子,多变量分析显示Pd为PAF的独立预测因子;以Pd≥45.0ms为切点值预测阵发性房颤的敏感性为90.6%,特异性为70.0%,阳性预测准确率为71.4%。结论Pd、Pmax、LAD及BNP联合分析,对PAF有重要的预测价值,尤其Pd可作为PAF的一个无创特异的独立预测指标。
Objective To investigate the relationship between the atrial electro-mechanical detection (Pd, Pmax, LAD) and cardiac neuroendocrine hormone (BNP) level and paroxysmal atrial fibrillation (PAF) and the predictive value of PAF. Methods 130 patients with paroxysmal atrial fibrillation and 92 patients without atrial fibrillation were selected as the control group. The P wave dispersion, the maximum P wave length, the maximum internal diameter of the left atrium (LAD) The levels of blood brain natriuretic peptide (BNP) were monitored and followed up for 1 to 3 years. The onset of atrial fibrillation in both groups was observed. The results were as follows: Pd (p <0.001), Pmax (p <0.001), LA (p <0.05) and BNP (p> 0.05) in patients with PAF were higher than those without PAF. Univariate analysis showed that LAD, Pmax and Pd were paroxysmal atrial Multivariate analysis showed that Pd was an independent predictor of PAF. The sensitivity and specificity of predicting paroxysmal atrial fibrillation with Pd≥45.0 ms as the cut-off point were 90.6% and 70.0% respectively. The positive predictive accuracy was 71.4%. Conclusions The combined analysis of Pd, Pmax, LAD and BNP has important predictive value for PAF. In particular, Pd can be used as a noninvasively independent predictor of PAF.