Jaroch Joanna, Rzyczkowska Barbara, Bociąga Zbigniew, Vriz Olga, Driussi Caterina, Loboz-Rudnicka Maria, Dudek Krzysztof, Łoboz-Grudzień Krystyna
Acta Cardiol. 2016 Apr;71(2):227-33. doi: 10.2143/AC.71.2.3141854.
The contribution of arterial functional and structural changes to left ventricular (LV) diastolic dysfunction has been the area of recent research. There are some studies on the relationship between arterial stiffness (a.s.) and left atrial (LA) remodelling as a marker of diastolic burden. Little is known about the association of arterial structural changes and LA remodelling in hypertension (H).
The aim of this study was to examine the relationship between carotid a.s. and intima-media thickness (IMT) and LA volume in subjects with H. The study included 245 previously untreated hypertensives (166 women and 79 men, mean age 53.7 ± 11.8 years). Each patient was subjected to echocardiography with measurement of LA volume, evaluation of left ventricular hypertrophy (LVH) and LV systolic/diastolic function indices, integrated assessment of carotid IMT and echo-tracking of a.s. and wave reflection parameters.
Univariate regression analysis revealed significant correlations between indexed LA volume and selected clinical characteristics, echocardiographic indices of LVH and LV diastolic/systolic function and a.s./wave reflection parameters. The following parameters were identified as independent determinants of indexed LA volume on multivariate regression analysis: diastolic blood pressure (beta = -0.229, P < 0.001), left ventricular mass index (LVMI; beta = 0.258, P < 0.001), E/e’ index (ratio of early mitral flow wave velocity – E to early diastolic mitral annular velocity – e’; beta = 0.266, P = 0.001), augmentation index (AI; beta = 0.143, P = 0.008) and body mass index (BMI; beta = 0.132, P = 0.017). No correlations between indexed LA volume and IMT were found.
There is a significant relationship between carotid arterial stiffness but not intima-media thickness and LA volume in patients with untreated hypertension.
动脉功能和结构变化对左心室舒张功能障碍的影响一直是近期的研究领域。关于动脉僵硬度（a.s.）与作为舒张期负荷标志物的左心房（LA）重塑之间的关系已有一些研究。而关于高血压（H）患者中动脉结构变化与LA重塑之间的关联则知之甚少。
本研究旨在探讨高血压患者颈动脉a.s.、内膜中层厚度（IMT）与LA容积之间的关系。该研究纳入了245例未经治疗的高血压患者（166例女性和79例男性，平均年龄53.7±11.8岁）。对每位患者进行超声心动图检查，测量LA容积，评估左心室肥厚（LVH）及左心室收缩/舒张功能指标，综合评估颈动脉IMT以及a.s.和波反射参数的回声跟踪。
单因素回归分析显示，标准化LA容积与选定的临床特征、LVH的超声心动图指标以及左心室舒张/收缩功能和a.s./波反射参数之间存在显著相关性。多因素回归分析确定以下参数为标准化LA容积的独立决定因素：舒张压（β=-0.229，P<0.001）、左心室质量指数（LVMI；β=0.258，P<0.001）、E/e’指数（二尖瓣早期血流速度E与二尖瓣环舒张早期速度e’之比；β=0.266，P=0.001）、增强指数（AI；β=0.143，P=0.008）和体重指数（BMI；β=0.132，P=0.017）。未发现标准化LA容积与IMT之间存在相关性。
未经治疗的高血压患者中，颈动脉僵硬度与LA容积之间存在显著关系，但与内膜中层厚度无关。
