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根据动脉高血压患者左心室肥厚消退情况分析阵发性心房颤动的患病率

Prevalence of paroxysmal atrial fibrillation depending on the regression of left ventricular hypertrophy in arterial hypertension.

作者信息

Hennersdorf Marcus G, Schueller Per O, Steiner Stephan, Strauer Bodo E

机构信息

Department of Cardiology, Pneumology and Angiology, Heinrich-Heine-University, Duesseldorf, Germany.

出版信息

Hypertens Res. 2007 Jun;30(6):535-40. doi: 10.1291/hypres.30.535.

Abstract

Arterial hypertension (HTN) represents one of the major causes of atrial fibrillation, a cardiac arrhythmia with high prevalence and comorbidity. The aim of this study was to investigate whether paroxysmal atrial fibrillation can be treated by the regression of left ventricular hypertrophy achieved by antihypertensive therapy. Included in the present study were 104 patients who had had HTN for more than 1 year. None of them suffered from coronary heart disease. All patients were investigated by 24-h Holter ECG and echocardiography at baseline and after a mean of 24 months. Patients were divided into two groups: group A consisted of those (53.8%) who showed a regression of the left ventricular muscle mass index (LVMMI) during the follow-up (154.9+/-5.1 vs. 123.5+/-2.8 g/m(2)), and group B those (45.2%) who showed a progression of LVMMI (122.2+/-3.2 vs. 143.2+/-3.2 g/m(2)). In group A the prevalence of atrial fibrillation decreased from 12.5% to 1.8% (p<0.05), while it was increased in group B from 8.5% to 17.0%. The left atrial diameter was reduced following antihypertensive therapy in group A from 39.1+/-5.3 mm to 37.4+/-4.6 mm (p<0.01) and increased in group B from 37.0+/-0.7 mm to 39.0+/-0.9 mm (p<0.01). We conclude that a regression of the left ventricular muscle mass leads to a reduction of left atrial diameter and consecutively to a decrease in the prevalence of intermittent atrial fibrillation. This may be explained by a better left ventricular diastolic function following decreased vascular and extravascular resistance of the coronary arteries. This relation shows the benefits of causal antihypertensive therapy for the treatment of paroxysmal atrial fibrillation.

摘要

动脉高血压(HTN)是心房颤动的主要病因之一,心房颤动是一种患病率和合并症都很高的心律失常。本研究的目的是调查通过降压治疗实现左心室肥厚消退是否可以治疗阵发性心房颤动。本研究纳入了104例患有高血压超过1年的患者。他们均无冠心病。所有患者在基线时以及平均24个月后接受了24小时动态心电图和超声心动图检查。患者被分为两组:A组由那些(53.8%)在随访期间左心室肌肉质量指数(LVMMI)出现消退的患者组成(154.9±5.1 vs. 123.5±2.8 g/m²),B组由那些(45.2%)LVMMI出现进展的患者组成(122.2±3.2 vs. 143.2±3.2 g/m²)。在A组中,心房颤动的患病率从12.5%降至1.8%(p<0.05),而在B组中则从8.5%增至17.0%。A组患者在降压治疗后左心房直径从39.1±5.3 mm降至37.4±4.6 mm(p<0.01),而B组从37.0±0.7 mm增至39.0±0.9 mm(p<0.01)。我们得出结论,左心室肌肉质量的消退导致左心房直径减小,并继而导致间歇性心房颤动患病率降低。这可能是由于冠状动脉血管和血管外阻力降低后左心室舒张功能改善所致。这种关系显示了因果性降压治疗对阵发性心房颤动治疗的益处。

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