Boschat J, le Mehaute H, le Potier J, Gilard M, Roriz R, Jobic Y, Etienne Y, Genet L, Blanc J J, Penther P
Services de cardiologie, CHU Morvan, Brest.
Arch Mal Coeur Vaiss. 1989 Dec;82(12):2003-8.
Two groups of patients of comparable age, one comprising 12 subjects without detectable cardiac disease and the other comprising 38 patients with calcific aortic stenosis (CAS) underwent clinical, electrocardiographic, echocardiographic and haemodynamic studies to assess the degree and significance of left atrial hypertrophies in CAS. The volume of the left atrium (LA) was globally increased in CAS (maximum volume 68 per cent: 26/38) and LA ejection fraction was decreased in 60 per cent of patients (23/38). However, the maximum volume was only moderately greater than that of normal subjects (+38 per cent). The most specific non-invasive investigation for left atrial assessment is echocardiography. There was a linear relationship between LA angiographic volume and echocardiographic antero-posterior dimension (r = 0.43; p less than 1 x 10(-2)). The duration of the P wave in S2 was a specific (75 per cent) but relatively insensitive (27 per cent) sign of LA dilatation in pure CAS. On the other hand, the Morris index based on the surface of the P terminal force in V1 was quite sensitive (77 per cent) but not very specific (25 per cent). The maximum LA volume was not related to left ventricular volume, the severity of CAS, diastolic indices of compliance or left ventricular mass. However, the minimum LA volume (after atrial systole) was related to left ventricular end diastolic (r = 0.35, p less than 0.05) and end systolic volume (r = 0.34, p less than 0.05). The LA ejection fraction was inversely related to mean pulmonary capillary pressure (r = 0.34, p less than 5 x 10(-2).(ABSTRACT TRUNCATED AT 250 WORDS)
两组年龄相仿的患者，一组由12名未检测出心脏病的受试者组成，另一组由38名患有钙化性主动脉瓣狭窄（CAS）的患者组成，他们接受了临床、心电图、超声心动图和血流动力学研究，以评估CAS中左心房肥厚的程度和意义。CAS患者的左心房（LA）容积整体增加（最大容积增加68%：26/38），60%的患者（23/38）左心房射血分数降低。然而，最大容积仅比正常受试者略大（+38%）。评估左心房最具特异性的非侵入性检查是超声心动图。左心房血管造影容积与超声心动图前后径之间存在线性关系（r = 0.43；p小于1×10⁻²）。在单纯CAS中，S2导联P波时限是左心房扩张的一个特异性（75%）但相对不敏感（27%）的征象。另一方面，基于V1导联P波终末力面积的莫里斯指数相当敏感（77%）但特异性不强（25%）。左心房最大容积与左心室容积、CAS严重程度、舒张顺应性指标或左心室质量无关。然而，左心房最小容积（心房收缩后）与左心室舒张末期（r = 0.35，p小于0.05）和收缩末期容积（r = 0.34，p小于0.05）相关。左心房射血分数与平均肺毛细血管压呈负相关（r = 0.34，p小于5×10⁻²）。（摘要截断于250字）
