与甲状腺毒性房颤预后相关的因素

D. A. Ponomartseva, A. Babenko
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In patients with a history of thyrotoxicosis the hospitalization rate due to cardiovascular pathology, and due to atrial fibrillation (AF), in particular, is higher than in the general population, even after the radical treatment of thyrotoxicosis.The development of prediction tools for mentioned above TAF complications and adverse outcomes, would make it possible to create more detailed and high-quality guidelines for the management of patients with thyrotoxicosis-induced AF. At the same time, the predictors of TAF thromboembolic complications and TAF maintenance after the euthyroid state is achieved, are not well currently understood.AIM: The purpose of this study was to identify risk factors for TAF adverse outcomes: thromboembolic events and the lack of spontaneous reversion to sinus rhythm after the euthyroidism was achieved.MATERIALS AND METHODS: This is a retrospective study of 70 patients aged 24 to 70 years with a history of overt thyrotoxicosis and TAF. 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引用次数: 0

摘要

背景:甲状腺毒性心房颤动(TAF)与总死亡率和心血管死亡率的增加有关,主要是由于血栓栓塞事件。因此,预防血栓栓塞是TAF治疗的重要组成部分。因此,确定TAF血栓栓塞并发症的预测因素似乎很有趣。TAF是一个潜在的可逆状态。然而,并非所有患者在甲状腺功能亢进后都能自发恢复窦性心律。在有甲状腺毒症病史的患者中,即使在甲状腺毒症根治后,因心血管病理,特别是心房颤动(AF)引起的住院率也高于一般人群。上述TAF并发症和不良结局预测工具的发展,将有可能为甲状腺毒功能诱发的房颤患者的管理创造更详细和高质量的指南。同时,TAF血栓栓塞并发症和甲状腺功能正常后TAF维持的预测因素目前尚不清楚。目的:本研究的目的是确定TAF不良结局的危险因素:血栓栓塞事件和实现甲状腺功能亢进后缺乏自发恢复窦性心律。材料和方法:这是一项回顾性研究,70例24 - 70岁有明显甲状腺毒症和TAF病史的患者。对所有参与者的以下参数进行分析:TAF引起的血栓栓塞事件,甲状腺功能亢进后自发性窦性心律恢复的存在,以及与TAF不良结局因素相关的潜在因素:许多临床和人口因素,超声心动图数据和TAF病程特征。通过回归分析研究这些潜在的预测因素对血栓栓塞风险和TAF维持的影响。确定危险因素的分界点由受试者工作特征(ROC)曲线确定。结果:分析显示,TAF在研究参数中唯一独立的血栓栓塞并发症预测因子是大左心房直径(>4.3 cm),达到甲状腺功能正常状态后TAF维持的预测因子包括大左心室舒张末期尺寸(>4.5 cm)和存在左心房扩张。结论:在本研究中,确定了与TAF血栓栓塞并发症和甲状腺功能恢复后TAF持续时间相关的超声心动图参数。这可能对未来TAF不良后果风险评估工具的开发有用。
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Factors, associated with the outcomes of the thyrotoxic atrial fibrillation
BACKGROUND: Thyrotoxic atrial fibrillation (TAF) is associated with an increase in total and cardiovascular mortality, mainly due to the thromboembolic events. Therefore, thromboembolism prevention is an important TAF treatment component. Thus, it seems interesting to identify TAF thromboembolic complications predictors.TAF is a potentially reversible state. However, the spontaneous reversion to sinus rhythm after the euthyroidism achievement does not occur in all patients. In patients with a history of thyrotoxicosis the hospitalization rate due to cardiovascular pathology, and due to atrial fibrillation (AF), in particular, is higher than in the general population, even after the radical treatment of thyrotoxicosis.The development of prediction tools for mentioned above TAF complications and adverse outcomes, would make it possible to create more detailed and high-quality guidelines for the management of patients with thyrotoxicosis-induced AF. At the same time, the predictors of TAF thromboembolic complications and TAF maintenance after the euthyroid state is achieved, are not well currently understood.AIM: The purpose of this study was to identify risk factors for TAF adverse outcomes: thromboembolic events and the lack of spontaneous reversion to sinus rhythm after the euthyroidism was achieved.MATERIALS AND METHODS: This is a retrospective study of 70 patients aged 24 to 70 years with a history of overt thyrotoxicosis and TAF. The following parameters were analyzed in all participants: thromboembolic events due to TAF, the presence of the spontaneous reversion to sinus rhythm after the euthyroidism was achieved and potentially associated with TAF adverse outcomes factors: a number of clinical and demographic factors, echocardiography data and characteristics of the TAF course. Regression analysis was performed to study the effect of these potential predictors on the risk of the thromboembolism and TAF maintenance. The cut-off points for the identified risk factors were determined by receiver operating characteristic (ROC) curves creating.RESULTS: The analysis showed that the only independent TAF thromboembolic complications predictor among studied parameters was the large left atrium diameter (>4.3 cm), and the predictors of TAF maintenance after the euthyroid state is achieved included the large left ventricle end-diastolic size (>4.5 cm) and the presence of left atrium dilation.CONCLUSION: In this study, echocardiographic parameters associated with TAF thromboembolic complications and TAF persistence after euthyroid state is achieved, were identified. This may be useful for the TAF adverse outcomes risk assessment tools development in the future.
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