原发性高血压伴房颤患者左心重构的特点

Characteristics of Left Heart Remodeling and Function in Essential Hypertensive Patients with Atrial Fibrillation

背景心房颤动(AF)是最常见的心律失常,原发性高血压(EH)在人群中的发病率较高,使之成为与AF相关的最常见的疾病。因而预测EH病人发生AF的危险因素在临床上具有实用性,而有关原发高血压伴心房颤动(EH+AF)病人左心重塑特点的研究较少。目的研究EH+AF患者左心重构及其功能特点、临床意义,对EH患者发生AF的危险因素作初步探讨。方法入选EH+AF组224例(男120例,女104例),EH组171例(男97例,女74例),单纯心房颤动组(AF组)166例(男90例,女76例),对照组为年龄和性别匹配的健康体检者157例(男93例,女64例)。采用超声心动图检测舒张末期室间隔厚度(IVSTd)、舒张末期左室后壁厚度(LVPWTd)、舒张末期左室内径(LVEDD)、收缩末期左室内径(LVESD)、左房内径(LAD)、左室射血分数(LVEF)、每搏输出量(SV)、心排血量(CO),计算左室质量(LVM)、左室质量指数(LVMI)及左室壁相对厚度(RWT)。结果EH组与EH+AF组的收缩压、舒张压明显高于对照组和AF组(P<0.05)。4组间IVSTd、LVPWTd、LVESD、LVEDD、LAD、RWT值均以EH+AF组最大,与其他3组差异均有统计学意义(P<0.05),而EH及AF两因素对LVESD、LAD及RWT均具有交互效应(P<0.05)。4组间LVM、LVMI值均以EH+AF组最大,EH+AF组的LVEF和左室短轴缩短率(FS)值明显低于其他3组(P<0.05),EH及AF对LVM、LVMI、FS及LVEF值具有交互效应(P<0.05)。结论EH或AF发生时,患者的左心结构及功能亦发生改变,EH+AF时这种变化则更为显著。

Background Atrial fibrillation （AF） is one of the most prevalent arrthythmias. Hypertension independently accounts for more AF cases than any other risk factors. Therefore, prevention of risk factors in patients with essential hypertensives（EH） is important for early prevention and diagnosis of AF. However, only a few data are available regarding left ventricle remodeling in essential hypertensive patients with atrial fibrillation（EH ＋AF）. Objective To study the characteristics of left heart remodeling and function and its clinical significance in EH＋AF, and predict some risk factors of AF. Methods All 561 patients were recruited which included EH＋AF （n=224）, EH alone（n= 171）, AF alone（n= 166） with normal subjects as control（n= 157）. Interventricula septal thickness at end-diastole（IVSTd）, posterior left ventrieular wall thickness at end-diastole（LVPWTd）, left ventricular end-diastolic dimension（LVEDD）, left ventricular end-systolic dimension（LVESD）, left atrial dimension （LAD）, left ventricular ejection fraction stroke volume（LVEF）, stroke volume（SV）cardiac output（CO）were measured with echoeardiography. Left ventrieular mass（LVM）, left ventricular mass index（LVMI）and relative wall thickness （RWT）were calculated. Results LVM, LVMI, IVSTd, LVPWTd, LVESD, LVEDD, LAD, RWT in the EH＋ AF group were significantly greater than those in the AF alone or EH alone patients（P〈0.05）, and complicated with significantly lower LVER, FS（P〈0.05）. Conclusion Left ventricular function and structure were altered in the EH or AF patient, while the most severe change was found in EH co-existed with AF.