Saraiva Roberto M, Matsumura Yoshiki, Yamano Tetsuhiro, Greenberg Neil, Thomas James D, Shiota Takahiro
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Am J Cardiol. 2010 Aug 1;106(3):409-16. doi: 10.1016/j.amjcard.2010.03.043. Epub 2010 Jun 18.
Pulmonary artery hypertension (PAH) increases mortality in patients with severe aortic stenosis. We hypothesized that left atrial (LA) dysfunction would be related to PAH in patients with severe aortic stenosis complicated by left ventricular (LV) systolic dysfunction. The data from 70 patients with severe aortic stenosis and LV systolic dysfunction were analyzed. From the transmitral flow, the peak early (E) and late (A) diastolic velocities were obtained. From the pulmonary vein flow, the peak S-wave, D-wave, and reversed atrial wave velocities were determined. The right ventricular systolic pressure was measured in 50 patients and averaged 38 +/- 13 mm Hg. Patients with PAH (n = 19) presented with greater LV diameters, E/A ratio, E-wave velocity, LV mass index, reversed atrial wave velocity, and LA volume (p <0.05) and lower S/D ratio and total and active LA emptying fractions (p <0.05). Simple linear regression analysis revealed that the LA volumes and total and active LA emptying fractions displayed the strongest correlations with the right ventricular systolic pressure. Multiple regression analysis revealed that the minimum LA volume (r = 0.61, p = 0.0001) independently correlated with the right ventricular systolic pressure, irrespective of the aortic valve (AV) area or gradient. In patients who underwent an echocardiographic examination >or=1 month after AV replacement, LA function had improved significantly. The degree of improvement was related to the degree of recovery of the LV diastolic function and diameter. In conclusion, in patients with severe aortic stenosis and concomitant LV systolic dysfunction, the LA function parameters displayed the strongest correlations with the right ventricular systolic pressure, irrespective of the AV area or gradient and were impaired in patients with PAH. LA function recovered after AV replacement. Additional studies are warranted to determine the prognostic significance of LA function in this setting.
肺动脉高压（PAH）会增加重度主动脉瓣狭窄患者的死亡率。我们假设，在合并左心室（LV）收缩功能障碍的重度主动脉瓣狭窄患者中，左心房（LA）功能障碍与PAH有关。分析了70例重度主动脉瓣狭窄和LV收缩功能障碍患者的数据。从二尖瓣血流中获取舒张早期（E）和晚期（A）峰值速度。从肺静脉血流中确定峰值S波、D波和逆向心房波速度。在50例患者中测量了右心室收缩压，平均为38±13 mmHg。PAH患者（n = 19）的LV直径、E/A比值、E波速度、LV质量指数、逆向心房波速度和LA容积更大（p <0.05），而S/D比值以及LA总排空分数和有效排空分数更低（p <0.05）。简单线性回归分析显示，LA容积以及LA总排空分数和有效排空分数与右心室收缩压的相关性最强。多元回归分析显示，最小LA容积（r = 0.61，p = 0.0001）与右心室收缩压独立相关，与主动脉瓣（AV）面积或压力阶差无关。在AV置换术后≥1个月接受超声心动图检查的患者中，LA功能有显著改善。改善程度与LV舒张功能和直径的恢复程度有关。总之，在重度主动脉瓣狭窄并伴有LV收缩功能障碍的患者中，无论AV面积或压力阶差如何，LA功能参数与右心室收缩压的相关性最强，且PAH患者的LA功能受损。AV置换术后LA功能恢复。有必要进行更多研究以确定在此情况下LA功能的预后意义。
