Acar Gürkan, Sayarlioğlu Mehmet, Akçay Ahmet, Sökmen Abdullah, Sökmen Gülizar, Yalçintaş Sila, Nacar Alper Buğra, Gündüz Mehmet, Tuncer Cemal
Department of Cardiology, Medicine Faculty of Kahramanmaraş Sütçü Imam University, Kahramanmaraş, Turkey.
Turk Kardiyol Dern Ars. 2009 Oct;37(7):447-53.
The aim of this study was to evaluate atrial electromechanical delay measured by tissue Doppler imaging (TDI) and left atrial (LA) mechanical functions in patients with rheumatoid arthritis (RA).
The study included 68 patients (53 females, 15 males; mean age 43.7 years) with RA. Using TDI, atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum), and right ventricular tricuspid annulus (PA tricuspid). Left atrial volumes (maximal, minimal, and pre-systolic) were measured by the method of discs in the apical four-chamber view and were indexed to body surface area. Mechanical function parameters of the LA were calculated. The results were compared with those of 41 age- and gender-matched healthy volunteers (32 females, 9 males; mean age 41.9 years).
Patients with RA had significantly prolonged PA lateral, PA septum, and intra- (PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical delays compared to controls (p<0.0001, p=0.05, p<0.0001, and p<0.0001, respectively). Left atrial volumes were similar in the two groups (p>0.05). Left atrial passive emptying fraction was significantly decreased, LA active emptying volume and active emptying fraction were increased in RA patients (p=0.05, p=0.01, and p<0.0001; respectively). Interatrial electromechanical delay was correlated with systolic blood pressure (r=0.20, p=0.04), left ventricular mass index (r=0.22, p=0.02), C-reactive protein (CRP) (r=0.27, p=0.005), and LA active emptying fraction (r=0.29, p=0.002). In linear regression analysis, LA active emptying fraction and CRP were independent variables of interatrial electromechanical delay (beta=0.28, p=0.002 and beta=0.25, p=0.006, respectively).
Prolonged electromechanical delays and impaired LA mechanical functions may be an early manifestation of subclinical cardiac involvement in RA patients.
本研究旨在评估采用组织多普勒成像（TDI）测量的类风湿关节炎（RA）患者的心房机电延迟及左心房（LA）机械功能。
该研究纳入了68例RA患者（53例女性，15例男性；平均年龄43.7岁）。使用TDI从二尖瓣环外侧（PA外侧）、二尖瓣环间隔（PA间隔）和右心室三尖瓣环（PA三尖瓣）测量心房机电耦合（PA）。通过心尖四腔心切面的圆盘法测量左心房容积（最大、最小和收缩前期），并将其指数化至体表面积。计算LA的机械功能参数。将结果与41例年龄和性别匹配的健康志愿者（32例女性，9例男性；平均年龄41.9岁）的结果进行比较。
与对照组相比，RA患者的PA外侧、PA间隔以及房内（PA间隔 - PA三尖瓣）和房间（PA外侧 - PA三尖瓣）机电延迟显著延长（分别为p<0.0001、p = 0.05、p<0.0001和p<0.0001）。两组的左心房容积相似（p>0.05）。RA患者的左心房被动排空分数显著降低，左心房主动排空容积和主动排空分数增加（分别为p = 0.05、p = 0.01和p<0.0001）。房间机电延迟与收缩压（r = 0.20，p = 0.04）、左心室质量指数（r = 0.22，p = 0.02）、C反应蛋白（CRP）（r = 0.27，p = 0.005）和左心房主动排空分数（r = 0.29，p = 0.002）相关。在线性回归分析中，左心房主动排空分数和CRP是房间机电延迟的独立变量（β分别为0.28，p = 0.002和β为0.25，p = 0.006）。
机电延迟延长和左心房机械功能受损可能是RA患者亚临床心脏受累的早期表现。
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