Cuspidi Cesare, Negri Francesca, Sala Carla, Valerio Cristiana, Mancia Giuseppe
Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy.
Blood Press. 2012 Feb;21(1):24-30. doi: 10.3109/08037051.2011.618262. Epub 2011 Oct 13.
Left atrial (LA) enlargement is a powerful risk factor for cardiovascular diseases; little information is available about its prevalence and correlates in subjects free of overt cardiac disease seen in echocardiographic practice.
We evaluated the prevalence of LA enlargement (LAE) and the relationship with left ventricular (LV) mass and diastolic function in subjects with preserved LV systolic function referred to an echocardiographic study for routine clinical indications.
1104 subjects (mean age 58 ± 16 years, 46% men, 57% hypertensives) underwent a comprehensive echo-Doppler examination. LAE and LV hypertrophy (LVH) were defined as LA volume index (LAVI) >29 ml/m(2) and LV mass index (LVMI) >50 g/h(2.7), respectively. Abnormalities of LV relaxation and LV filling were diagnosed by age-related thresholds of lateral annular velocity (Ei) and by early mitral flow velocity to Ei ratio (E/Ei) ≥16, respectively.
Overall, 10% of echocardiographic examinations fulfilled the criteria for LAE, 46% for LVH, 45% for altered LV relaxation and 5% for altered LV filling index. LVH progressively increased from 25% to 75% across LAVI quartiles. More patients in the highest quartile exhibited abnormal indexes of LV relaxation and LV filling compared with lower quartiles. In multivariate analysis, LV mass index (β = 0.408), age (β = 0.188), E/Ei ratio (β = 0.140) and Ei (β = 0.140) emerged as major correlates of LAE (p at least <0.01 for all).
LAE is a frequent finding in patients with preserved systolic function seen in current practice; this abnormality is strongly related to LVH and to diastolic dysfunction. Early detection of LAE may identify patients at higher cardiovascular risk and promote appropriate prevention strategies.
左心房(LA)扩大是心血管疾病的一个重要危险因素;关于在超声心动图检查中未患明显心脏病的患者中其患病率及相关因素的信息较少。
我们评估了因常规临床指征接受超声心动图检查的左心室(LV)收缩功能正常的患者中左心房扩大(LAE)的患病率及其与左心室质量和舒张功能的关系。
1104名受试者(平均年龄58±16岁,46%为男性,57%患有高血压)接受了全面的超声多普勒检查。LAE和左心室肥厚(LVH)分别定义为左心房容积指数(LAVI)>29 ml/m²和左心室质量指数(LVMI)>50 g/h².7。左心室舒张功能异常和左心室充盈异常分别通过与年龄相关的侧环速度(Ei)阈值和二尖瓣血流速度与Ei比值(E/Ei)≥16来诊断。
总体而言,10%的超声心动图检查符合LAE标准,46%符合LVH标准,45%左心室舒张功能改变,5%左心室充盈指数改变。LVH在LAVI四分位数中从25%逐渐增加到75%。与较低四分位数相比,最高四分位数中的更多患者表现出左心室舒张和充盈的异常指标。在多变量分析中,左心室质量指数(β = 0.408)、年龄(β = 0.188)、E/Ei比值(β = 0.140)和Ei(β = 0.140)是LAE的主要相关因素(所有p值至少<0.01)。
在目前的临床实践中,LAE在收缩功能正常的患者中很常见;这种异常与LVH和舒张功能障碍密切相关。LAE的早期检测可能识别出心血管风险较高的患者,并促进适当的预防策略。