Jaroch Joanna, Rzyczkowska Barbara, Bociąga Zbigniew, Łoboz-Rudnicka Maria, Kruszyńska Ewa, Rychard Wojciech, Dudek Krzysztof, Poręba Rafał, Łoboz-Grudzień Krystyna
Department of Cardiology, T. Marciniak Hospital , Wroclaw , Poland.
Blood Press. 2015 Apr;24(2):72-8. doi: 10.3109/08037051.2014.986929. Epub 2014 Dec 29.
Recently, there has been growing interest in an interplay of vascular mechanics and heart function (arterial-ventricular-atrial coupling). The contribution of arterial stiffness (AS) to left atrial (LA) enlargement is unclear. The aim of this study was to verify whether the association between carotid AS and LA volume in untreated arterial hypertension is independent of such confounders as age, sex, body mass index (BMI), blood pressure, left ventricular hypertrophy (LVH), left ventricular (LV) diastolic and systolic function. The study included 133 patients, among them 107 individuals with hypertension (51 men and 56 women, mean age 56.8 ± 10.3 years) and 26 matched controls. Each patient was subjected to echocardiography, ultrasonographic measurement of mean carotid intima-media thickness (IMT) and echo-tracking assessment of AS and wave reflection. LA volume was calculated by ellipsoid method. The indexed LA volume showed significant linear correlations with age (r = 0.32; p < 0.05), BMI (r = 0.21; p < 0.05), pulse pressure (r = 0.26; p < 0.05), B-type natriuretic peptide (r = 0.64; p < 0.05), LV end-diastolic volume (r = 0.42; p < 0.05), LV mass index (LVMI; r = 0.58; p < 0.05), septum thickness (r = 0.40; p < 0.05), posterior wall thickness (r = 0.34; p < 0.05), early filling wave of mitral inflow (E; r = 0.30; p < 0.05), early diastolic myocardial velocity of mitral annulus (e'; r = - 0.22; p < 0.05), E/e' ratio (r = 0.45; p < 0.05), IMT (r = 0.26; p < 0.05) and augmentation index (AI; r = 0.27; p < 0.05). Progressive multivariate analysis identified LVMI, age, AI and BMI as independent determinants of indexed LA volume in patients with arterial hypertension. The study showed the significant relationship between wave reflection expressed by AI and LA structural remodeling, which supports the hypothesis of arterial-atrial coupling in hypertension.
近年来，人们对血管力学与心脏功能之间的相互作用（动脉 - 心室 - 心房耦合）越来越感兴趣。动脉僵硬度（AS）对左心房（LA）扩大的影响尚不清楚。本研究的目的是验证在未经治疗的动脉高血压患者中，颈动脉AS与LA容积之间的关联是否独立于年龄、性别、体重指数（BMI）、血压、左心室肥厚（LVH）、左心室（LV）舒张和收缩功能等混杂因素。该研究纳入了133例患者，其中107例高血压患者（51例男性和56例女性，平均年龄56.8±10.3岁）和26例匹配的对照组。对每位患者进行了超声心动图检查、平均颈动脉内膜中层厚度（IMT）的超声测量以及AS和波反射的回声跟踪评估。LA容积通过椭球体法计算。标准化LA容积与年龄（r = 0.32；p < 0.05）、BMI（r = 0.21；p < 0.05）、脉压（r = 0.26；p < 0.05）、B型利钠肽（r = 0.64；p < 0.05）、LV舒张末期容积（r = 0.42；p < 0.05）、LV质量指数（LVMI；r = 0.58；p < 0.05）、室间隔厚度（r = 0.40；p < 0. 05）、后壁厚度（r = 0.34；p < 0.05）、二尖瓣流入早期充盈波（E；r = 0.30；p < 0.05）、二尖瓣环舒张早期心肌速度（e'；r = - 0.22；p < 0.05）、E/e'比值（r = 0.45；p < 0.05）、IMT（r = 0.26；p < 0.05）和增强指数（AI；r = 0.27；p < 0.05）均呈显著线性相关。逐步多变量分析确定LVMI、年龄、AI和BMI是动脉高血压患者标准化LA容积的独立决定因素。该研究表明，由AI表示的波反射与LA结构重塑之间存在显著关系，这支持了高血压中动脉 - 心房耦合的假说。
