Gerdts Eva, Oikarinen Lasse, Palmieri Vittorio, Otterstad Jan Erik, Wachtell Kristian, Boman Kurt, Dahlöf Björn, Devereux Richard B
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Hypertension. 2002 Mar 1;39(3):739-43. doi: 10.1161/hy0302.105683.
Left ventricular hypertrophy has been suggested to mediate the relation between hypertension and left atrial enlargement, with associated risks of atrial fibrillation and stroke. However, less is known about correlates of left atrial size in hypertensive patients with left ventricular hypertrophy. We assessed left atrial size by echocardiography in 941 hypertensive patients, age 55 to 80 (mean, 66) years, with electrocardiographic left ventricular hypertrophy at baseline in the Losartan Intervention For Endpoint reduction in hypertension study. Enlarged left atrial diameter (women, >3.8 cm; men, >4.2 cm) was present in 56% of women and 38% of men (P<0.01). Compared with the 512 patients with normal left atrial size, the 429 patients with enlarged left atrium more often had mitral regurgitation, atrial fibrillation, and echocardiographic left ventricular hypertrophy. They also had higher age, systolic blood pressure, pulse pressure, weight, body mass index, left ventricular internal chamber dimension, stroke volume, and mass and lower relative wall thickness and ejection fraction (all, P<0.05). In logistic regression analysis, left atrial enlargement was related to left ventricular hypertrophy and eccentric geometry; greater body mass index, systolic blood pressure, and age; female gender; mitral regurgitation; and atrial fibrillation (all, P<0.05). Thus, left atrial size in hypertensive patients with electrocardiographic left ventricular hypertrophy is influenced by gender, age, obesity, systolic blood pressure, and left ventricular geometry independently of left ventricular mass and presence of mitral regurgitation or atrial fibrillation.
左心室肥厚被认为介导了高血压与左心房扩大之间的关系，并伴有心房颤动和中风的相关风险。然而，对于患有左心室肥厚的高血压患者，左心房大小的相关因素知之甚少。在氯沙坦干预降低高血压终点研究中，我们对941例年龄在55至80岁（平均66岁）、基线时心电图显示左心室肥厚的高血压患者进行了超声心动图检查以评估左心房大小。56%的女性和38%的男性存在左心房直径增大（女性>3.8 cm；男性>4.2 cm）（P<0.01）。与512例左心房大小正常的患者相比，429例左心房增大的患者更常出现二尖瓣反流、心房颤动和超声心动图显示的左心室肥厚。他们的年龄、收缩压、脉压、体重、体重指数、左心室内径、每搏输出量和质量也更高，而相对室壁厚度和射血分数更低（均P<0.05）。在逻辑回归分析中，左心房扩大与左心室肥厚和离心性几何形态、更高的体重指数、收缩压和年龄、女性性别、二尖瓣反流以及心房颤动有关（均P<0.05）。因此，心电图显示左心室肥厚的高血压患者的左心房大小受性别、年龄、肥胖、收缩压和左心室几何形态的影响，独立于左心室质量以及二尖瓣反流或心房颤动的存在。
