| Objective :to understand the general data,stroke related risk factors,and primary prevention status and prognosis of patients with valvular heart disease(VHD)and atrial fibrillation(AF)in Chengdu during the past 2013~2015 years.Providing theoretical basis and support for effective and safe stroke level prevention for patients with VHD with atrial fibrillation.Methods: WE collected patients in Sichuan Provincial People’s Hospital from December 2013-2015 year in April were diagnosed with atrial fibrillation of VHD fiber and met the inclusion criteria of 233 cases of hospitalized patients with general information and stroke factors,disease and follow-up of patients in 2 years and the prognosis after 2 years.According to the etiology,the subjects were divided into rheumatic valvular heart disease with AF group(n=126),degenerative valvular heart disease with AF group(n=82),and other valvular heart disease AF group(n=25).The data of three groups of patients,including general information,stroke related risk factors,disease characteristics,follow-up treatment for 2 years,and prognosis after 2 years,were collected by EXCEL,and analyzed by SPSS 13 software.The quantitative data were described with mean standard deviation(x ±s),and the average number of each group was compared with the analysis of variance;The qualitative data were described by the composition ratio or rate(%),and the P<0.05 difference was statistically significant with the χ2test or the exact probability.To observe the clinical characteristics of patients with VHD combined with atrial fibrillation,the status and effect of prevention of stroke.Results: 1)233 cases,with the average age of 62.6 + 14.2 years,150 women(64.4%),and 83 men(35.6%),were in accordance with the inclusion criteria.82 cases of degenerative valvular disease(35.2%),the average age of 74.5 + 10.2 years.25 patients of other types of valvular heart disease(10.7%).2)22 of the patients with paroxysmal atrial fibrillation accounted for about 9.4%,and 211 of the patients with persistent atrial fibrillation were 90.6%.3)Among the subjects 208 of the left atrial enlargement(89.3%)。4)Persistent atrial fibrillation was the main type of atrial fibrillation in all groups.More than 88.9% of the patients in each group were accompanied by increased left atrium.2there were 20 patients(8.6%)who did not take any interventions,8.6%(125)of anticoagulant therapy and 91(39.1%)of anti platelet therapy.26 patients were treated with left atrial appendage occlusion(11.2%),and 19 of the left atrial appendage thrombectomy were 8.2%.In the rheumatoid VHD group,anticoagulant was the main group(83.3%).The degenerative VHD group was mainly antiplatelet(57.3%).5)Valvular VHD combined with atrial fibrillation according to EHRA classification,EHRA I level 67 people,EHRA II level 101 people,EHRA III level 40 people,EHRA IV class of 25 people.120 cases of EHRA I and II were taken to prevent stroke by anticoagulant drugs,accounting for 71.4%.Patients With VAF have some similar risk factors for stroke in patients with NVAF,using the CHA2DS2-VASc score to evaluate the risk factors,scoring more than 2 men and women aged 3 of high-risk population for a total of 173 people(74.2%),of which 100 people receiving anticoagulation therapy(57.8%),taking warfarin anticoagulation for 85 people,the crowd of 85%,taking 15 new anticoagulant drugs accounted for anticoagulation in the crowd of 15%,55 people accounted for 31.8% of platelet aggregation.The risk of stroke in high-risk patients with rheumatic heart disease and atrial fibrillation is 84,accounting for 48.6% of patients with rheumatic heart disease and atrial fibrillation,73 of patients with degenerative valvular heart disease and 73 patients with atrial fibrillation,and 89% of patients with degenerative heart disease and atrial fibrillation.The risk of stroke in high-risk patients with rheumatic heart disease and atrial fibrillation is 84,accounting for 48.6% of patients with rheumatic heart disease and atrial fibrillation,73 of patients with degenerative valvular heart disease and 73 patients with atrial fibrillation,and 89% of patients with degenerative heart disease and atrial fibrillation.The risk of anticoagulation was 98.8% in the high risk group of rheumatic VHD group and 58.9% in the high risk group of degenerative VHD.6)The patients were followed up for 2 years.11.1% of the 18 patients who did not adhere to stroke primary prevention had cerebral infarction.The proportion of cerebral infarction in patients with primary stroke prevention was 0.5%.Conclusions:1)rheumatic valvular heart disease combined with atrial fibrillation is still the most important type of VHD associated with atrial fibrillation,followed by degenerative VHD with atrial fibrillation.The proportion of degenerative valvular heart valvular disease with atrial fibrillation is significantly higher than that in the past,and the average age is high.2)Valvular atrial fibrillation is dominated by persistengt atrial fibrillation.3)Patients with valvular atrial fibrillation have more left atial enlargement of the heart structure.4)The majority of patients with VHD associated with atrial fibrillation have a high risk of stroke.Anticoagulation with warfarin is still the main method to prevent stroke in patients with VAF.The primary prevention of stroke in patients with degenerative VHD and atrial fibrillation is mainly anti platelet.Anticoagulant 、anti platelet and surgical methods can effectively prevent the onset of cerebral apoplexy in patients with VHD combined with atrial fibrillation(AF)in 2 years.The effect of anti coagulant on stroke prevention is better than that of nti platelet aggregation. |
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