Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University, Pyeongchon Dong, Dongan Gu, Anyang City, Gyeonggi Do, South Korea.
Int J Cardiol. 2009 May 29;134(3):336-41. doi: 10.1016/j.ijcard.2008.08.019. Epub 2008 Sep 19.
The clinical and echocardiographic parameters associated with the risk of developing new onset atrial fibrillation (AF) in congestive heart failure (CHF) have not been studied comprehensively. We determined if dyssynchronous left atrial (LA) lengthening and contraction predicted future development of new onset AF in patients with CHF.
One hundred fifty-eight patients who were admitted for CHF without past or current AF were evaluated. We measured the time to peak velocity and time to peak strain with reference to the QRS complex during ventricular systole (reservoir) and late diastole (atrial contraction) in mid-portion of 4 LA walls. Dyssynchronous atrial lengthening and contraction (atrial dyssynchrony) was defined as the standard deviation of each parameter.
New onset AF developed in 21 patients (13.3%) after a mean follow-up of 43+/-15 months. Based on univariate Cox analysis, older age, larger LA dimension and volume index, lower LA fractional shortening, and the presence of atrial dyssynchrony were associated with new onset AF. In multivariate Cox analysis, atrial dyssynchrony based on strain (>39 ms, HR 10.0, p=0.003) and LA size (> or =45 mm, HR 4.3, p=0.016) were independent predictors of new onset AF in CHF.
We demonstrated that atrial dyssynchrony based on strain is the strongest univariate and multivariate predictor for new onset AF in hospitalized patients with CHF.
充血性心力衰竭（CHF）患者发生新发心房颤动（AF）的临床和超声心动图参数尚未得到全面研究。我们确定左心房（LA）不同步拉长和收缩是否可预测 CHF 患者新发 AF 的发生。
评估了 158 例因 CHF 而入院且既往或目前无 AF 的患者。我们测量了心室收缩期（储器）和舒张晚期（心房收缩）时 4 个 LA 壁中部 QRS 波群参考的峰值速度和峰值应变时间。用各参数的标准差来定义不同步的 LA 拉长和收缩（心房不同步）。
平均随访 43+/-15 个月后，21 例（13.3%）患者新发 AF。单因素 Cox 分析显示，年龄较大、LA 尺寸和容积指数较大、LA 分数缩短较小和存在心房不同步与新发 AF 相关。多因素 Cox 分析显示，基于应变的心房不同步（>39 ms，HR 10.0，p=0.003）和 LA 大小（>或=45 mm，HR 4.3，p=0.016）是 CHF 患者新发 AF 的独立预测因子。
我们证实，基于应变的心房不同步是住院 CHF 患者新发 AF 的最强单因素和多因素预测因子。
