Zapolski Tomasz, Wysokiński Andrzej
Katedry i Kliniki Kardiologii Akademii Medycznej w Lublinie.
Wiad Lek. 2006;59(5-6):346-51.
Frequency of occurrence of atrial fibrillation (FA) increases with age. In the elderly this arrhythmia might influence the enlargement and function of left atrium (LA) and its appendage (LAA). The aim of this study was to assess the association between age of patients and selected echocardiographic parameters concerning left atrium.
120 consecutive patients (52 women and 68 men) with FA were studied 36-89 years old (mean 68.7 +/- 10.9). Patients were divided into two groups using a cut-off value age of 70 years. Older than 70 years were 64 patients, whereas below this age were 56 persons. Duration time of arrhythmia did not differ significantly between studied groups. In all patients transthoracic (TTE) and transoesophageal (TEE) echocardiography were performed to assess selected echocardiographic parameters concerning left atrium (LA) and its appendage (LAA). During TTE were measured: LA maximal diameter in M-mode (LAmax), LA transversal diameter in 4-CH (LAtrans), LA longitudinal diameter in 4-CH (LAlong), LA circulum in 4-CH (LAcirc), LA area in 4-CH (LAarea). Consequently TEE was done to assess LAA transversal diameter (LAAtrans), LAA longitudinal diameter (LAAlong), LAA circulum (LAAcirc), LAA area (LAAarea), spontaneous echocardiographic contrast (SEC), thrombus (THR), maximal LAA outflow velocity (LAAF), maximal LAA inflow velocity (LAAB), integral of LAA outflow velocity (LAAFintg) and integral of LAA inflow velocity (LAABintg).
LAmax (4.91 +/- 0.61 vs. 4.22 +/- 0.49), LAtrans (4.75 +/- 0.71 vs. 4.11 +/- 0.44) and LAarea (31.85 +/- 6.9 vs. 27.51 +/- 6.54) were significantly greater in older patients compared to those below 70 years old. LAlong, LAcirc, LAarea, LAA trans, LAAlong, LAAcirc did not differ between studied groups. Thrombi in LAA were detected rarely in study population and were found often in older patients (in 2 vs. 6 patients). In almost 2/3 older patients SEC in LAA was visualized, which was markedly frequent when compared to younger group. In older patients parameters characterizing LAA function had significantly lower values than in younger patients (LAAF respectively 19.8 +/- 9.16 vs. 28.57 +/- 10.7, LAAB respectively 21.6 +/- 8.12 vs. 31.81 +/- 10.88).
In patients with atrial fibrillation left atrium and its appendage diameters are greater in the elderly. Left atrium appendage function is more deteriorated in older patients with atrial fibrillation. During atrial fibrillation thrombus formation and appearance of spontaneous echocardiographic contrast is more often in the elderly.
心房颤动（AF）的发生率随年龄增长而增加。在老年人中，这种心律失常可能会影响左心房（LA）及其心耳（LAA）的扩大和功能。本研究的目的是评估患者年龄与所选左心房超声心动图参数之间的关联。
对120例连续的房颤患者（52例女性和68例男性）进行研究，年龄在36 - 89岁之间（平均68.7±10.9岁）。采用70岁的年龄分界值将患者分为两组。70岁以上的患者有64例，而70岁以下的患者有56例。研究组之间心律失常的持续时间无显著差异。对所有患者进行经胸（TTE）和经食管（TEE）超声心动图检查，以评估所选的关于左心房（LA）及其心耳（LAA）的超声心动图参数。在TTE检查期间测量：M型左心房最大直径（LAmax）、四腔心切面左心房横径（LAtrans）、四腔心切面左心房纵径（LAlong）、四腔心切面左心房周长（LAcirc）、四腔心切面左心房面积（LAarea）。随后进行TEE检查，以评估心耳横径（LAAtrans）、心耳纵径（LAAlong）、心耳周长（LAAcirc）、心耳面积（LAAarea）、自发超声造影（SEC）、血栓（THR）、心耳最大流出速度（LAAF）、心耳最大流入速度（LAAB）、心耳流出速度积分（LAAFintg）和心耳流入速度积分（LAABintg）。
与70岁以下的患者相比，老年患者的LAmax（4.91±0.61对4.22±0.49）、LAtrans（4.75±0.71对4.11±0.44）和LAarea（31.85±6.9对27.51±6.54）显著更大。LAlong、LAcirc、LAarea、LAA横径、LAAlong、LAAcirc在研究组之间无差异。在研究人群中，心耳血栓很少被检测到，且在老年患者中更常见（分别为2例对6例）。在几乎2/3的老年患者中，心耳可见SEC，与年轻组相比明显更频繁。老年患者中心耳功能的特征参数值明显低于年轻患者（LAAF分别为19.8±9.16对28.57±10.7，LAAB分别为21.6±8.12对31.81±10.88）。
在房颤患者中，老年人的左心房及其心耳直径更大。老年房颤患者的心耳功能恶化更明显。在房颤期间，老年人血栓形成和自发超声造影的出现更常见。
