Badran Hala Mahfouz, Eid Manal Abd Elwahed, Michael Atef
Cardiology Department, Faculty of Medicine, Menoufiya University, Shebin Elkom, Egypt.
Echocardiography. 2007 Oct;24(9):911-22. doi: 10.1111/j.1540-8175.2007.00493.x.
Onset of atrial fibrillation in hypertensive patients is usually associated with a high occurrence of cardiovascular complications. Despite its leading importance as a highly prevalent and modifiable risk factor, only a few data are available regarding the predictors of paroxysmal atrial fibrillation (PAF) in hypertensive patients.
This study was undertaken to determine if PAF could be predicted in hypertensive patients while in sinus rhythm using Doppler-derived indexes and the plasma B-type natriuretic peptide (BNP) concentration.
We prospectively evaluated 165 consecutive patients with hypertension and no known history of PAF or cardiovascular events who attended the cardiology outpatient clinic. Their mean age was 62 +/- 12, 94 male, 71 female. The conventional echocardiographic parameters were measured including: left atrial (LA) volume, mitral regurgitation (MR), left ventricular (LV) function, LV mass. The ratio of transmitral peak E-wave velocity to flow propagation velocity (E/V(p)), ratio of E-wave to mitral annular early diastolic velocity (E/E(a)) obtained by Doppler tissue at the lateral and septal corners of the mitral annulus were calculated. The plasma BNP was measured at the study entry.
After a mean follow-up of 15 +/- 3 months, PAF (symptomatic attacks or documented on the ECG) occurred in 36 (21.8%) of 165 patients. The patients with PAF had significant higher BNP levels than those with sinus rhythm (160 +/- 109.8 vs. 87.9 +/- 57.7 pg/ml, P < 0.001) Also, E/E(a) and E/V(p) ratios were significantly higher in hypertensives with PAF (15.1 +/- 2.8 vs. 8.39 +/- 1.33, P < 0.001), and (1.65 +/- 1.29 vs. 1.19 +/- 1.06, P < 0.001) respectively. In univariate analysis, E/V(p), E/E(a), and BNP and LV hypertrophy were significant predictors of PAF. Barely E/V(p) and E/E(a) remained independently significant after adjustment of clinical and other echocardiographic variables by multivariate logistic regression analysis (odd ratio: 3.36, P < 0.001 and 4.93, P < 0.001 respectively). A cutoff value of > or =1.7 for E/V(p) predicted PAF with 91% sensitivity and 88% specificity; E/E(a) >12 has sensitivity 98%, specificity 89%, while BNP>170 pg/ml has 83% and 72% specificity, respectively, for prediction of PAF in hypertensive patients.
Paroxysmal atrial fibrillation could be predicted in hypertensive patients while in sinus rhythm using Doppler-derived indexes. Increased E/V(p), E/E(a) ratios and elevated BNP appear to be useful parameters to identify patients at heightened risk. They may reflect early left ventricular dysfunction and atrial hypertension in this population.
高血压患者房颤的发作通常与心血管并发症的高发生率相关。尽管作为一种高度普遍且可改变的危险因素，其具有重要的主导地位，但关于高血压患者阵发性房颤（PAF）预测因素的数据却很少。
本研究旨在确定在窦性心律的高血压患者中，是否可以使用多普勒衍生指标和血浆B型利钠肽（BNP）浓度来预测PAF。
我们前瞻性地评估了165例连续就诊于心脏病门诊的高血压患者，这些患者无PAF或心血管事件的已知病史。他们的平均年龄为62±12岁，男性94例，女性71例。测量了常规超声心动图参数，包括：左心房（LA）容积、二尖瓣反流（MR）、左心室（LV）功能、LV质量。计算二尖瓣峰值E波速度与血流传播速度之比（E/V(p)），以及通过二尖瓣环外侧和间隔角处的多普勒组织获得的E波与二尖瓣环舒张早期速度之比（E/E(a)）。在研究开始时测量血浆BNP。
平均随访15±3个月后，165例患者中有36例（21.8%）发生PAF（有症状发作或心电图记录）。PAF患者的BNP水平显著高于窦性心律患者（160±109.8 vs. 87.9±57.7 pg/ml，P<0.001）。此外，PAF高血压患者的E/E(a)和E/V(p)比值也显著更高（分别为15.1±2.8 vs. 8.39±1.33，P<0.001），以及（1.65±1.29 vs. 1.19±1.06，P<0.001）。在单因素分析中，E/V(p)、E/E(a)、BNP和LV肥厚是PAF的显著预测因素。在通过多因素逻辑回归分析调整临床和其他超声心动图变量后，仅E/V(p)和E/E(a)仍具有独立显著性（比值比：分别为3.36，P<0.001和4.93，P<0.001）。E/V(p)≥1.7的临界值预测PAF的敏感性为91%，特异性为88%；E/E(a)>12的敏感性为98%，特异性为89%，而BNP>170 pg/ml预测高血压患者PAF的特异性分别为83%和72%。
在窦性心律的高血压患者中，可以使用多普勒衍生指标预测阵发性房颤。E/V(p)、E/E(a)比值增加和BNP升高似乎是识别高危患者的有用参数。它们可能反映了该人群早期的左心室功能障碍和心房高压。
