左心房对估计左心室充盈压变化的功能和解剖反应。
Functional and Anatomic Responses of the Left Atrium to Change in Estimated Left Ventricular Filling Pressure.
机构信息
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
South Western Sydney Clinical School, The University of New South Wales, Liverpool Hospital, Sydney, Australia.
出版信息
J Am Soc Echocardiogr. 2015 Dec;28(12):1428-1433.e1. doi: 10.1016/j.echo.2015.07.028. Epub 2015 Sep 4.
BACKGROUND
Left atrial (LA) remodeling and dysfunction reflect chronic exposure to elevated left ventricular (LV) filling pressures. The aim of this longitudinal cohort study was to define the effect of reducing LV filling pressures on reverse remodeling of LA volume (LAV) and function.
METHODS
This retrospective cohort included 195 patients (52% men; mean age, 64 ± 14 years) in sinus rhythm with LA dilatation and sequential echocardiograms (median interval, 1 year; interquartile range, 0.5-2.0 years). One hundred seventy-four patients underwent medical therapy (82 with reduced E/e' ratios), and 21 underwent surgery for valvular heart disease. Biplane LAV (normal value, ≤ 68 mL for men, ≤ 62 mL for women), LA strain (ε) (normal value, >32%) and LV filling pressures (assessed as E/e' ratio; normal value, <13) were measured.
RESULTS
Although LAV at baseline and follow-up were 88 ± 27 and 81 ± 24 mL, LA ε and E/e' ratio remained stable at 26 ± 11% and 14 ± 7, respectively. Changes in E/e' ratio were associated with changes in LAV (r = 0.37, P < .001) and LA ε (r = -0.51 P < .001). Although reduced E/e' ratio or improved LA ε at follow-up occurred in about 50% of the patients, only 26% (51 of 195) had normalized LAV. Compared with surgery, successful reduction of E/e' with medical therapy was less effective in reducing LAV (P < .001) but produced similar improvement in LA ε. Having normal or improved E/e' ratio at follow-up was not associated with normalization of LAV (relative risk, 1.29 [P = .326] and 1.22 [P = .421], respectively) but was associated with normalized LA ε (relative risk, 2.04 [P = .011] and 1.86 [P = .017], respectively) independently of LAV.
CONCLUSIONS
Reduction in LV filling pressures reduces but rarely normalizes LAV. The strong association of reduced LV filling pressure with improved LA function indicated by LA longitudinal ε supports the increasing interest of LA ε measurement.
背景
左心房（LA）重构和功能障碍反映了慢性左心室（LV）充盈压升高的影响。本纵向队列研究的目的是确定降低 LV 充盈压对 LA 容量（LAV）和功能逆向重构的影响。
方法
本回顾性队列纳入 195 例（52%为男性；平均年龄 64±14 岁）窦性节律伴 LA 扩张和连续超声心动图（中位数间隔 1 年；四分位距 0.5-2.0 年）。174 例患者接受药物治疗（82 例降低 E/e'比值），21 例接受瓣膜性心脏病手术。双平面 LAV（正常值，男性≤68ml，女性≤62ml）、LA 应变（ε）（正常值，>32%）和 LV 充盈压（E/e'比值评估；正常值，<13）。
结果
尽管基线和随访时 LAV 分别为 88±27 和 81±24ml，但 LA ε 和 E/e'比值仍分别稳定在 26±11%和 14±7。E/e'比值的变化与 LAV（r=0.37，P<0.001）和 LA ε（r=-0.51，P<0.001）的变化相关。尽管约 50%的患者在随访时出现降低 E/e'比值或改善 LA ε，但只有 26%（195 例中的 51 例）的 LAV 恢复正常。与手术相比，药物治疗成功降低 E/e'比值对降低 LAV 的效果较差（P<0.001），但对 LA ε 的改善效果相似。随访时 E/e'比值正常或改善与 LAV 正常化无关（相对风险，1.29[P=0.326]和 1.22[P=0.421]），但与 LA ε 正常化相关（相对风险，2.04[P=0.011]和 1.86[P=0.017]），与 LAV 无关。
结论
降低 LV 充盈压可降低但很少能使 LAV 正常化。LA 纵向应变ε强烈提示降低 LV 充盈压与改善 LA 功能有关，这支持了 LA ε 测量的兴趣不断增加。
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