Cioffi Giovanni, Gerdts Eva, Cramariuc Dana, Tarantini Luigi, Di Lenarda Andrea, Pulignano Giovanni, Sindaco Donatella Del, Stefenelli Carlo, de Simone Giovanni
Department of Cardiology, Villa Bianca Hospital, Trento, Italy;
Exp Clin Cardiol. 2010 Fall;15(3):e45-51.
Left atrial (LA) systolic force (LASF) is significantly increased in chronic heart failure (CHF), arterial hypertension (HT) and aortic stenosis (AS). The increase is proportional to the degree of left ventricular hypertrophy and diastolic dysfunction.
To assess the magnitude of changes in maximal LA volume (LAV(max)) and LASF in systolic CHF compared with other cardiac diseases, and to assess whether the left atrium remodels differently and works in response to specific conditions affecting diastolic function and to individual factors associated with LA alterations.
LAV(max) and LASF were measured and evaluated by two-dimensional Doppler echocardiography in 94 patients with systolic CHF and normal left ventricular filling pressure, 100 control patients, 181 patients with HT, 40 patients with idiopathic hypertrophic cardiomyopathy (HCMP) and 85 patients with AS. The prevalence of LA dilation and supernormal LASF (defined as values of LAV(max) and LASF exceeding two SDs of the mean of controls) was measured in all groups.
LAV(max) and LASF were 7.1±2 mL/m(3) and 7.8±4 kdynes in controls, and 11.0±4 mL/m(3) and 19.7±11 kdynes in systolic CHF patients, respectively (both P<0.001). These values were significantly higher than in patients with HT, but similar to those with AS and HCMP. LA dilation and supernormal LASF were detected in 13% and 11% of patients with HT, 32% and 59% of patients with AS, 26% and 43% of patients with HCMP, and 41% and 56% of patients with systolic CHF, respectively (all P<0.01). In multiple logistic analysis, systolic CHF represented the strongest predictor of supernormal LASF. It was not independently associated with LA dilation, which was mainly related to indexes of volume load.
LAV(max) and LASF were markedly increased in patients with systolic CHF, with a magnitude that was significantly higher than that of HT patients, but similar to that measured in HCMP and AS patients. In the present community population with various cardiac diseases, systolic CHF represented the most powerful stimulus for increasing LASF and was not related to LA dilation.
慢性心力衰竭（CHF）、动脉高血压（HT）和主动脉狭窄（AS）患者的左心房（LA）收缩力（LASF）显著增加。这种增加与左心室肥厚和舒张功能障碍的程度成正比。
评估收缩性CHF患者与其他心脏病相比，最大左心房容积（LAV(max)）和LASF的变化幅度，并评估左心房在影响舒张功能的特定条件以及与LA改变相关的个体因素作用下，是否会有不同的重塑和功能变化。
采用二维多普勒超声心动图对94例收缩性CHF且左心室充盈压正常的患者、100例对照患者、181例HT患者、40例特发性肥厚型心肌病（HCMP）患者和85例AS患者进行LAV(max)和LASF的测量与评估。测量所有组中LA扩张和超常LASF（定义为LAV(max)和LASF值超过对照组均值的两个标准差）的发生率。
对照组的LAV(max)和LASF分别为7.1±2 mL/m(3)和7.8±4 kdynes，收缩性CHF患者分别为11.0±4 mL/m(3)和19.7±11 kdynes（均P<0.001）。这些值显著高于HT患者，但与AS和HCMP患者相似。HT患者中LA扩张和超常LASF的检出率分别为13%和11%，AS患者分别为32%和59%，HCMP患者分别为26%和43%，收缩性CHF患者分别为41%和56%（均P<0.01）。在多因素逻辑分析中，收缩性CHF是超常LASF的最强预测因素。它与LA扩张无独立相关性，LA扩张主要与容量负荷指标有关。
收缩性CHF患者的LAV(max)和LASF显著增加，其幅度显著高于HT患者，但与HCMP和AS患者测量值相似。在目前患有各种心脏病的社区人群中，收缩性CHF是增加LASF的最有力刺激因素，且与LA扩张无关。
