Maiello Maria, Sharma Rakesh K, Matteo Ciccone M, Reddy Humananth K, Palmiero Pasquale
AS Department of Cardiology, Brindisi District, Italy.
Echocardiography. 2009 Aug;26(7):772-8. doi: 10.1111/j.1540-8175.2008.00889.x.
Chronic pressure and volume overload may cause different type of left atrial (LA) remodeling in left atrial enlargement (LAE) leading to different cardiovascular outcomes. These two different patterns of LA remodeling can be discriminated by LA eccentricity index (LAEi). The goal of our study was to evaluate an association between LAEi, LV diastolic dysfunction (LVDD), and mitral regurgitation (MR).
LAEi was calculated from 3D of left atrium (LA): anteroposterior (D1), superoinferior (D2), mediolateral (D3), and LAEi = D2x2/ (D1+D3). LAE was described as elongated left atrium (EA) if LAEi > or = 1.27, and spherical left atrium (SA) if LAEi < 1.27.
A group of 501 patients (10.4%) with LAE were categorized into two subgroups; 232 (46.3%) with EA and 269 (53.7%) with SA based on LAEi. Among 108 patients (21.6%) with LVDD without MR, 102 had EA and only 6 had SA (P < 0.0001). The cohort of 155(30.1%) patients with MR without LVDD, only 8 had EA and143 had SA (P < 0.0001). Of the total group of 501 patients, 59 had persistent AF and in this subgroup only 10 patients had EA and 49 patients had SA (P < 0.0001). There was a statistically significant difference for AF rate between EA-patients with LVDD without MR and SA-patients with MR without LVDD (P < 0.001).
LVDD may contribute to pressure overload LA remodeling in a way quite different from volume overload LA remodeling by MR. LAEi can discriminate two different LA morphologies with significantly different potential outcomes. It may identify patients associated with a higher rate of AF with a higher cardiovascular risk.
慢性压力和容量超负荷可能导致左心房扩大（LAE）时不同类型的左心房（LA）重塑，从而导致不同的心血管结局。这两种不同的LA重塑模式可通过LA偏心指数（LAEi）来区分。我们研究的目的是评估LAEi、左心室舒张功能障碍（LVDD）和二尖瓣反流（MR）之间的关联。
LAEi由左心房（LA）的三维数据计算得出：前后径（D1）、上下径（D2）、左右径（D3），且LAEi = D2×2 /（D1 + D3）。如果LAEi≥1.27，则LAE被描述为拉长型左心房（EA）；如果LAEi < 1.27，则为球形左心房（SA）。
一组501例（10.4%）LAE患者被分为两个亚组；根据LAEi，232例（46.3%）为EA型，269例（53.7%）为SA型。在108例（21.6%）无MR的LVDD患者中，102例为EA型，仅6例为SA型（P < 0.0001）。155例（30.1%）无LVDD的MR患者队列中，仅8例为EA型，143例为SA型（P < 0.0001）。在501例患者的总组中，59例有持续性房颤，在该亚组中，仅10例患者为EA型，49例患者为SA型（P < 0.0001）。无MR的LVDD的EA型患者与无LVDD的MR的SA型患者之间的房颤发生率存在统计学显著差异（P < 0.001）。
LVDD可能以与MR导致的容量超负荷LA重塑截然不同的方式促成压力超负荷LA重塑。LAEi可以区分两种具有显著不同潜在结局的不同LA形态。它可能识别出与较高房颤发生率和较高心血管风险相关的患者。
