心房颤动老年患者左心房重构特点分析

The evaluation of structural remodeling of the left atrium in elderly patients with non-valvular atrialfibrillation

目的分析老年心房颤动（房颤）患者左心房超声影像学特点，探讨左心房结构重构在老年房颤患者中的作用和可能机制。方法单中心横断面研究，人选2014年9月至2016年6月我院住院的194例非瓣膜性房颤患者，按年龄分为老年组（年龄≥60岁）129例，中青年对照组（年龄〈60岁）65例。收集临床资料，包括病史、身高、体重、血压、血糖、血脂等。采用超声心动图测量左心房相关指标，经食道超声心动图评价左心耳结构和血流速度。结果老年组女性和持续性房颤患者多于对照组，且CHA2DS2Vsc评分明显升高。老年组N末端脑钠肽（NT-ProBNP）水平高于对照组。老年组左心房前后径（39．1±4．4）mm、左心房面积（23．3±4．5）cm。均高于对照组（37．1±5．3）mm和（21．4±4．8）cm2（均P〈0．01）。左心房前后径、左心房面积和左房压与年龄和持续性房颤成正相关（r=0．213、-0．175、0．170，均P〈O．05），与左心室收缩功能成负相关（P〈0．05）。结论与中青年患者比较，老年房颤患者的左心房重构更为严重，提示年龄增长是老年患者左心房重构的不利因素。超声心动图检测的左心房结构参数能敏感反映心房重构程度，应作为老年房颤患者心房结构和功能的常规筛查手段。

Objective To assess the difference in left atrial properties between elderly and younger control subjects and the role of left atrium remodeling in patients of different ages with atrial fibrillation. Methods A total of 194 patients with non-valvular atrial fibrillation were enrolled from September 2014 to June 2016. Based on age,patients were divided into an elderly group （≥60 years,n =129） and a younger group （〈60 years,n=65）. We evaluated remodeling parameters for the left atrium using an Ultrasound Cardiography （UCG） system in 125 elder subjects, together with 64 control subjects. All remodeling parameters were recorded, including left atrial diameter （LAD）, left atrial square （LAS） ,left atrial pressure （LAP） and left ventricular end-diastolic dimension （LVEDD）. Results The elderly group had more female patients and more patients with persistent atrial fibrillation. Meanwhile,scores of CHA2DS2 Vse and levels of N-terminal pro-brain natriuretic peptide （NT-ProBNP） were significantly increased in elderly patients （both P〈0.05）. Moreover, the elderly group was associated with increased values of LAD and LAS[（39.1±4.4）mm vs. （37.1±5.3）mm,P 〈0.01 ; and（23.3± 4.5） cm2 vs. （21.4 ±4.8） cm2 ,P〈0.01 ; respectively], compared with those in the control group. Spearman＇s correlation analysis showed that LAD, LAS and LAP were all markedly related to age （r=0.213,P〈0.05;r=-0.175,P〈0.05;r=0.170, P〈0.05;respectively）, persistent onset of atrial fibrillation （r=0. 401,P〈0.05;r= 0. 446,P〈0.05;r=0. 160,P〈0.05 respectively）, and impaired heart function, measured by left ventricular ejection fraction （r=-0. 4371,P〈0.05;r=-0. 403,P〈0. 051r=-0. 364,P〈0.05 ;respectively） and NT-ProBNP （r=0. 485,P〈 0.01 ; r= 0. 483, P 〈 0.01; r = 0. 293, P〈0.01 ; respectively）. Conclusions Left atrial remodeling properties measured by the UCG system in the elderly with non valvular atrial fibrillation are more serious than those in mid-aged and young subjects. As a convenient and accurate assessment of remodeling parameters,the UCG system is an excellent option for measuring left atrial remodeling in the elderly population.