ObjectiveTo explore the association between preoperative, perioperative parameters, especially estimated glomerular filtration rate (eGFR) and postoperative atrial fibrillation (POAF) after modified extended Morrow procedure.MethodsA total of 300 hypertrophic obstructive cardiomyopathy (HOCM) patients who underwent modified extended Morrow procedure in our hospital from January 2012 to March 2018 were collected. There were 197 (65.67%) males and 103 (34.33%) females with an average age of 43.54±13.81 years. Heart rhythm was continuously monitored during hospitalization. The patients were divided into a POAF group (n=68) and a non-POAF group (n=232). The general data, perioperative parameters and echocardiographic results were collected by consulting medical records for statistical analysis. Univariate and multivariate logistic regression models were used to analyze the risk factors for POAF.ResultsOverall incidence of POAF during hospitalization was 22.67% (68/300). Compared with patients without POAF, patients with POAF were older, had higher incidence of chest pain and syncope, lower level of preoperative eGFR, higher body mass index and heart function classification (NYHA), larger preoperative left atrial diameter and left ventricular end diastolic diameter, and longer ventilator-assisted time, ICU stay and postoperative hospital stay. Age, heart function classification (NYHA)≥Ⅲ, hypertension, syncope history and eGFR were independent risk factors for POAF. Receiver operating characteristic curve analysis showed that the area under the curve of eGFR was 0.731 (95%CI 0.677-0.780, P<0.001), and the sensitivity and specificity were 82.4% and 57.8%, respectively.ConclusionIncreased age, high preoperative heart function classification (NYHA), hypertension, preoperative syncope history and decreased eGFR are independent risk factors for POAF in HOCM patients who underwent surgical septal myectomy. Preoperative decreased eGFR can moderately predict the occurrence of POAF after modified extended Morrow procedure.
摘要:目的:了解血肌酐清除率受損是否與冠心病患病率存在聯系。方法:納入2006年7月至2008年2月期間經冠狀動脈造影證實的冠心病患者及年齡、性別匹配的對照組,按血肌酐清除率值將患者分為正常［≥90 mg/（mL·173 m2)］,輕度受損［≥60 mg/（mL·1.73 m2）,lt;90 mg/（mL·1.73 m2)］和明顯受損［lt;60 mg/（mL·1.73 m2)］。比較冠心病組與對照組各組人群的比例有無差異。結果:研究期間共納入冠心病組和對照組患者各116例。在冠心病組中,血肌酐清除率正常患者82例、輕度受損29例、重度受損5例,對照組中,正常患者98例、輕度受損13例、重度受損5例,〖JP3〗兩組比較分布有統計學差異(χ2值7.517,P=0.023)。與對照組比較,冠心病組的血清肌酐值無明顯差異（Pgt;005)，〖JP〗冠心病組（103.29±51.08） μmol/L,對照組（102.67±41.21）μmol/L。結論:血肌酐清除率降低是冠心病的危險因素。Abstract: Objective: To disclose the relation of the estimated glomerular filtration rate (eGFR) and coronary artery disease. Methods：We analyzed eGFR in the patients with coronary artery disease confirmed by coronary angiography and the control, and compared the proportion of patients with reduced renal function in the different groups. Results: A total 116 cases were included in each group. Among these patients, normal renal function, mildly and severe reduced renal function was documented in 82, 29 and 5 in coronary artery disease group, and in 98, 13 and 5 in the control group, respectively. In comparison to the control, more patients with reduced eGFR were found in coronary artery disease group (χ2 value 7.517,P=0.023), although no significant difference was observed between both groups（Pgt;0.05). Conclusion: Reduced eGFR, even if mildly, could be regarded as the risk factor of coronary artery disease.