Tsang Teresa S M, Gersh Bernard J, Appleton Christopher P, Tajik A Jamil, Barnes Marion E, Bailey Kent R, Oh Jae K, Leibson Cynthia, Montgomery Samantha C, Seward James B
Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
J Am Coll Cardiol. 2002 Nov 6;40(9):1636-44. doi: 10.1016/s0735-1097(02)02373-2.
The objective of this study was to determine whether diastolic dysfunction is associated with increased risk of nonvalvular atrial fibrillation (NVAF) in older adults with no history of atrial arrhythmia.
Few data exist regarding the relationship between diastolic function and NVAF.
The clinical and echocardiographic characteristics of patients age > or =65 years who had an echocardiogram performed between 1990 and 1998 were reviewed. Exclusion criteria were history of atrial arrhythmia, stroke, valvular or congenital heart disease, or pacemaker implantation. Patients were followed up in their medical records to the last clinical visit or death for documentation of first AF.
Of 840 patients (39% men; mean [+/- SD] age, 75 +/- 7 years), 80 (9.5%) developed NVAF over a mean (+/- SD) follow-up of 4.1 +/- 2.7 years. Abnormal relaxation, pseudonormal, and restrictive left ventricular diastolic filling were associated with hazard ratios of 3.33 (95% confidence interval [CI], 1.5 to 7.4; p = 0.003), 4.84 (95% CI, 2.05 to 11.4; p < 0.001), and 5.26 (95% CI, 2.3 to 12.03; p < 0.001), respectively, when compared with normal diastolic function. After a number of adjustments, diastolic function profile remained incremental to history of congestive heart failure and previous myocardial infarction for prediction of NVAF. Age-adjusted Kaplan-Meier five-year risks of NVAF were 1%, 12%, 14%, and 21% for normal, abnormal relaxation, pseudonormal, and restrictive diastolic filling, respectively. CONCLUSIONS; The presence and severity of diastolic dysfunction are independently predictive of first documented NVAF in the elderly.
本研究的目的是确定在无房性心律失常病史的老年人中，舒张功能障碍是否与非瓣膜性心房颤动（NVAF）风险增加相关。
关于舒张功能与NVAF之间的关系，现有数据较少。
回顾了1990年至1998年间接受超声心动图检查的年龄≥65岁患者的临床和超声心动图特征。排除标准为房性心律失常、中风、瓣膜或先天性心脏病史或起搏器植入史。通过病历对患者进行随访，直至最后一次临床就诊或死亡，以记录首次房颤情况。
840例患者（39%为男性；平均[±标准差]年龄为75±7岁）中，在平均（±标准差）4.1±2.7年的随访期内，有80例（9.5%）发生了NVAF。与正常舒张功能相比，舒张功能异常、假性正常化和限制性左心室舒张期充盈的风险比分别为3.33（95%置信区间[CI]，1.5至7.4；p = 0.003）、4.84（95%CI，2.05至11.4；p < 0.001）和5.26（95%CI，2.3至12.03；p < 0.001）。经过多项调整后，舒张功能状况对于预测NVAF而言，在充血性心力衰竭病史和既往心肌梗死方面仍具有增量价值。年龄调整后的NVAF五年Kaplan-Meier风险在舒张功能正常、舒张功能异常、假性正常化和限制性舒张期充盈时分别为1%、12%、14%和21%。结论：舒张功能障碍的存在和严重程度可独立预测老年人首次记录到的NVAF。
