心房传导延迟及其与房颤风险患者左心房大小、左心房压力和左心室舒张功能障碍的关系。
Atrial conduction delay and its association with left atrial dimension, left atrial pressure and left ventricular diastolic dysfunction in patients at risk of atrial fibrillation.
作者信息
Vranka Ivan, Penz Peter, Dukát Andrej
机构信息
2nd Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
出版信息
Exp Clin Cardiol. 2007 Winter;12(4):197-201.
BACKGROUND
Atrial conduction delay and its association with left atrial dimension, left atrial pressure and left ventricular (LV) diastolic dysfunction in patients at risk of atrial fibrillation (AF) may be assessed by high-resolution electrocardiography of P wave.
OBJECTIVES
To determine how left atrial size, left atrial pressure and LV diastolic dysfunction, measured noninvasively by transthoracic echocardiography, influence atrial conduction time.
METHODS
Signal-averaged electrocardiography of P wave and echocardiogram were performed on 70 patients (average age of 63+/-10 years; 37 male and 33 female), divided into three groups: group A, patients with paroxysmal AF (n=29); group B, patients with type 2 diabetes mellitus and arterial hypertension, but without AF (n=23); and group C, healthy control patients (n=18). Standard statistical methods were used.
RESULTS
Filtered P wave duration, measured by signal-averaged electrocardiography, was significantly prolonged in group A and group B compared with control group C (138+/-12 ms and 125+/-9 ms versus 117+/-8 ms; P </= 0.001 and P </= 0.01, respectively). Left atrial diameter, area and volume were significantly increased in group A compared with group C (P </= 0.01, P </= 0.05 and P </= 0.001, respectively), but no significant differences were found in these dimensions between group B and group C. Left atrial pressure, determined with the Doppler echocardiographic parameter ratio of early diastolic transmitral velocity to mitral annular early diastolic velocity, was significantly higher in group A, as well in group B, than group C (P </= 0.05, P </= 0.01). As well, impaired LV relaxation was present more often in group A (42%) and group B (50%).
CONCLUSION
Atrial conduction delay in patients at risk of AF (patients with diabetes and hypertension in group B) was associated with increased left atrial pressure and impaired LV relaxation. Patients with paroxysmal AF (group A) presented left atrial dilation, increased left atrial pressure and impaired LV relaxation, and these factors were associated with more significantly prolonged atrial conduction in group A than in group B.
背景
房颤（AF）风险患者的心房传导延迟及其与左心房大小、左心房压力和左心室（LV）舒张功能障碍的关系可通过P波高分辨率心电图进行评估。
目的
确定经胸超声心动图无创测量的左心房大小、左心房压力和LV舒张功能障碍如何影响心房传导时间。
方法
对70例患者（平均年龄63±10岁；37例男性和33例女性）进行P波信号平均心电图和超声心动图检查，分为三组：A组，阵发性房颤患者（n = 29）；B组，2型糖尿病和动脉高血压但无房颤的患者（n = 23）；C组，健康对照患者（n = 18）。采用标准统计方法。
结果
与对照组C相比，A组和B组通过信号平均心电图测量的滤波P波持续时间显著延长（分别为138±12 ms和125±9 ms，而对照组为117±8 ms；P≤0.001和P≤0.01）。与C组相比，A组的左心房直径、面积和容积显著增加（分别为P≤0.01、P≤0.05和P≤0.001），但B组和C组在这些维度上未发现显著差异。通过多普勒超声心动图早期舒张期二尖瓣流速与二尖瓣环早期舒张期流速比值确定的左心房压力，A组和B组均显著高于C组（P≤0.05，P≤0.01）。此外，A组（42%）和B组（50%）更常出现LV舒张功能受损。
结论
AF风险患者（B组中的糖尿病和高血压患者）的心房传导延迟与左心房压力升高和LV舒张功能受损有关。阵发性房颤患者（A组）表现出左心房扩张、左心房压力升高和LV舒张功能受损，且这些因素与A组心房传导显著延长的相关性高于B组。
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