【作者】 刘方；

【导师】 赵韧；

【作者基本信息】 安徽医科大学 ， 内科学（心血管病）， 2025， 硕士

【摘要】 背景左心室肥厚(Left ventricular hypertrophy,LVH)是一种继发于左心室壁厚度增加、左心室腔扩大,或两者同时发生的左室质量增加的病症。多项临床研究指出,LVH通常与心脏性猝死的高风险相关,并且是心血管死亡的预测因子。左心室作为左心房的延续,两者互相影响,在持续性心房颤动(Persistent atrial fibrillation,Pe AF)疾病发展进程中,心房和心室共同经历了从电重构到结构重构的过程,LVH可能为其主要的早期改变之一。PeAF合并LVH患者的病因及预后尚未完全明确。目前学者们推测,这种病理改变可能与AF本身的直接影响(如心房重构、心室负荷增加和心输出量降低等)直接相关,同时也可能受到AF共病(如高血压(Hypertension,HTN)、糖尿病(Diabetes,DM)、肾功能不全等)协同作用的推动。这些因素共同作用下,进一步加重了心肌的重构和功能障碍。因此,深入研究AF与共病之间影响的交互机制,对于明确病因、优化治疗策略具有重要意义。目的本研究旨在探讨Pe AF患者合并LVH的危险因素及预后,通过结合临床经验和统计分析,筛选最具预测价值的变量,并构建相应的预测模型,以期将列线图结果与个体化治疗相结合,为不同风险水平的患者提供具体的综合干预措施。方法回顾性纳入于2022年1月至2023年10月期间在安徽医科大学第一附属医院起搏与电生理病区初次诊断且接受住院治疗的非瓣膜性Pe AF患者949例,并随机分为训练集(664例)和验证集(285例),通过单因素及多因素二元logistic回归分析筛选出Pe AF合并LVH的独立危险因素,并基于此构建列线图预测模型,通过受试者工作特征(ROC)曲线、校准曲线和决策曲线评估模型的预测性能。结果最终筛选出女性、高血压、糖尿病、RDW-SD、BMI、LAD、LVEF共7项独立危险因素,并将其纳入预测模型,训练集中的ROC曲线下面积为0.862(95%CI:0.834-0.890),验证集中的ROC曲线下面积为0.870(95%CI:0.829-0.911),显示出良好的预测效能。结论非瓣膜性Pe AF患者合并LVH的独立危险因素包括女性、HTN、DM、LAD、LVEF、BMI、RDW-SD。同时本研究还发现,在Pe AF患者中,与未合并LVH相比,合并LVH的患者发生HF、缺血性脑卒中及接受导管消融治疗术术后复发的风险更高。本研究通过将上述独立危险因素纳入构建的预测模型,表现出较高的预测能力和临床适用性。ROC曲线显示模型具有良好的敏感性和特异性,校准曲线表明模型预测结果与实际观察值吻合度较高。这一模型不仅可以帮助临床医生在Pe AF患者中早期识别LVH的高危人群,还可能为其个性化治疗提供依据。更多还原

【Abstract】 Background:Left ventricular hypertrophy(LVH)is a condition secondary to increased left ventricular wall thickness,left ventricular lumen enlargement,or both with increased left ventricular mass.Multiple clinical studies have indicated that LVH is often associated with a higher risk of sudden cardiac death and is a predictor of cardiovascular death.As a continuation of the left atrium,the left ventricle and the left ventricle interact with each other.In the development of Persistent atrial fibrillation(Pe AF),the atrium and the ventricle undergo a process from electrical remodeling to structural remodeling,and LVH may be one of the main and early changes.The etiology and prognosis of Pe AF patients with LVH have not been fully determined.At present,scholars speculate that such pathological changes may be directly related to the direct effects of AF itself(such as atrial remodeling,increased ventricular load and decreased cardiac output,etc.),and may also be driven by the synergistic effect of AF comorbidities(such as Hypertension(HTN),Diabetes(DM),renal insufficiency,etc.).Together,these factors further aggravate the remodeling and dysfunction of myocardium.Therefore,in-depth study of the interaction mechanism between AF and comorbidities is of great significance for identifying the etiology and optimizing treatment strategies.Objective:The purpose of this study was to explore the risk factors and prognosis of Pe AF patients with LVH.By combining clinical experience and statistical analysis,the variables with the most predictive value were screened,and the corresponding predictive model was constructed,with a view to combining the results of the column graph with individualized treatment,and providing specific comprehensive interventions for patients with different risk levels.Methods:A total of 949 patients with nonvalvular Pe AF who were initially diagnosed and hospitalized in the pacing and electrophysiology Ward of the First Affiliated Hospital of Anhui Medical University from January 2022 to October 2023 were retrospectively included,and randomly divided into a training set(664 cases)and a validation set(285cases).Independent risk factors for Pe AF combined with LVH were screened by univariate and multifactorial binary logistic regression analysis,and a nomogram prediction model was constructed based on this analysis.The predictive performance of the model was evaluated by receiver operating characteristic(ROC)curve,calibration curve and decision curve.Results:Seven independent risk factors,including female,hypertension,diabetes,RDW-SD,BMI,LAD and LVEF,were finally selected and included in the prediction model.The area under the ROC curve in the training set was 0.862(95%CI:0.834-0.890),and the area under the ROC curve in the validation set was 0.870(95%CI:0.829-0.911),showing good predictive power.Conclusion:Independent risk factors for LVH in patients with nonvalvular Pe AF included female,HTN,DM,LAD,LVEF,BMI,and RDW-SD.In addition,this study also found that in Pe AF patients,compared with those without LVH,patients with LVH had a higher risk of HF,ischemic stroke and recurrence after catheter ablation.This study demonstrated high predictive power and clinical applicability by incorporating the above independent risk factors into the constructed predictive model.ROC curve showed that the model had good sensitivity and specificity,and calibration curve showed that the predicted results of the model were in good agreement with the actual observed values.This model may not only help clinicians identify those at high risk for LVH early in Pe AF patients,but may also provide a basis for their personalized treatment.更多还原