Seneviratne B I, Reimers J
Repatriation General Hospital, Greenslopes, Qld., Australia.
Aust N Z J Med. 1990 Apr;20(2):127-34. doi: 10.1111/j.1445-5994.1990.tb01289.x.
Epidemiologists have not identified high risk groups nor the entire spectrum of heart disease, especially the subclinical forms underlying nonvalvular atrial fibrillation (NVAF) predisposing to cardioembolic (CE) stroke. We analysed 36 cases of 'isolated' NVAF among 106 consecutive cases of CE stroke after excluding cases of AF associated with valvular disease, myocardial infarcts, ischaemic and other cardio-myopathies (34 cases). This revealed echocardiographic left ventricular hypertrophy (LV mass index 136 +/- 25 g, vs normal 68 +/- 12 g p less than 0.001), enlarged left atria (left atrial area 27.4 +/- 3.6 cm2 vs normal 14.3+/- 1.6 cm2 p less than 0.001), normal systolic function and formed the largest group associated with CE stroke (34%), mean age 72.6 years--Study Group D. Eighty nine per cent had known or undetected hypertension compared to 60% in matched controls (x2 = 8.3 df = 1 p less than 0.01), and hypertension remained the predominant risk factor for left ventricular hypertrophy (LVH). Although all had echocardiographic LVH, 60% had neither electrocardiographic LVH nor cardiomegaly on chest X-ray. Hence usual epidemiologic methods may fail to detect these cases. Hypertensive heart disease is known to predispose to left atrial enlargement and AF. Progressive atrial enlargement is associated with increasing risk of embolic stroke. We conclude that NVAF associated with hypertensive heart disease forms a major component of the spectrum of heart disease associated with NVAF predisposing to CE stroke. Detection and treatment of hypertension to prevent or reverse LVH and atrial enlargement should be an important preventive measure.
流行病学家尚未确定心脏病的高危人群，也未明确心脏病的全貌，尤其是非瓣膜性心房颤动（NVAF）引发心源性栓塞（CE）性卒中的亚临床形式。我们在106例连续的CE性卒中病例中分析了36例“孤立性”NVAF，排除了与瓣膜病、心肌梗死、缺血性和其他心肌病相关的房颤病例（34例）。这显示出超声心动图左心室肥厚（左心室质量指数136±25 g，正常为68±12 g，p<0.001），左心房增大（左心房面积27.4±3.6 cm²，正常为14.3±1.6 cm²，p<0.001），收缩功能正常，且是与CE性卒中相关的最大组（34%），平均年龄72.6岁——研究组D。89%的患者已知或未被检测出患有高血压，而匹配对照组中这一比例为60%（x² = 8.3，自由度 = 1，p<0.01），高血压仍是左心室肥厚（LVH）的主要危险因素。尽管所有患者超声心动图均显示LVH，但60%的患者心电图无LVH表现，胸部X线检查也无心脏扩大。因此，常规流行病学方法可能无法检测出这些病例。已知高血压性心脏病易导致左心房扩大和房颤。进行性心房扩大与栓塞性卒中风险增加相关。我们得出结论，与高血压性心脏病相关的NVAF是与NVAF相关的心脏病谱中易引发CE性卒中的主要组成部分。检测和治疗高血压以预防或逆转LVH和心房扩大应是一项重要的预防措施。
