Department of Cardiology, Valvular Heart Disease Clinic, University Hospital, CHU Sart Tilman, University of Liège, Liège, Belgium.
Am J Cardiol. 2010 Oct 15;106(8):1157-62. doi: 10.1016/j.amjcard.2010.06.029.
The aim of this study was to determine the impact of aortic stenosis (AS) on the different components of left atrial (LA) function. The study consisted of a total of 52 consecutive patients with severe AS (aortic valve area < 1 cm(2)) and 20 normal subjects matched for gender, heart rate, body surface area, and baseline systolic blood pressure. Phasic LA longitudinal function was assessed using tissue Doppler imaging. LA peak systolic (reservoir function), early diastolic (conduit function), and late diastolic (active function) strain rates were measured. During late diastole, LA peak strain (active function) was also measured. Mitral annular systolic, early diastolic (Ea), and late diastolic (Aa) velocities were also measured. Compared with controls, all strain values were significantly reduced in patients with AS. By multivariate regression analysis, mitral E-wave deceleration time (p = 0.033) and E/Ea ratio (p = 0.02, R(2) = 0.43) emerged as independently associated with LA peak systolic strain rate. Ea was the sole determinant of LA early diastolic strain rate (p < 0.0001, R(2) = 0.42), whereas LA late diastolic strain rate was independently related to aortic valve area (p = 0.031) and Aa (p = 0.022, R(2) = 0.51). In conclusion, in patients with severe AS, the 3 components of LA function are reduced. LA reservoir dysfunction is related to left ventricular filling pressures, whereas LA conduit dysfunction depends on left ventricular relaxation. Active LA dysfunction is related to the severity of AS and late left ventricular diastolic function.
本研究旨在探讨主动脉瓣狭窄（AS）对左心房（LA）功能不同成分的影响。研究共纳入 52 例严重 AS 患者（主动脉瓣面积<1cm²）和 20 例性别、心率、体表面积和基础收缩压相匹配的正常对照者。采用组织多普勒成像评估 LA 节段性纵向功能。测量 LA 收缩期峰值应变率（储备功能）、早期舒张期（管道功能）和晚期舒张期（主动功能）。在晚期舒张期，还测量 LA 收缩期峰值应变（主动功能）。同时测量二尖瓣环收缩期、早期舒张期（Ea）和晚期舒张期（Aa）速度。与对照组相比，AS 患者的所有应变值均显著降低。多元回归分析显示，二尖瓣 E 波减速时间（p=0.033）和 E/A 比值（p=0.02，R²=0.43）与 LA 收缩期峰值应变率独立相关。Ea 是 LA 早期舒张应变率的唯一决定因素（p<0.0001，R²=0.42），而 LA 晚期舒张应变率与主动脉瓣面积（p=0.031）和 Aa（p=0.022，R²=0.51）独立相关。结论：在严重 AS 患者中，LA 功能的 3 个成分均降低。LA 储备功能障碍与左心室充盈压相关，而 LA 管道功能障碍取决于左心室舒张功能。LA 主动功能障碍与 AS 严重程度和晚期左心室舒张功能相关。
