Bakkestrøm Rine, Andersen Mads J, Ersbøll Mads, Bro-Jeppesen John, Gustafsson Finn, Køber Lars, Hassager Christian, Møller Jacob E
Department of Cardiology, Odense University Hospital, Odense, Denmark.
From the Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Odense, Denmark.
Int J Cardiol. 2016 Nov 15;223:717-722. doi: 10.1016/j.ijcard.2016.08.228. Epub 2016 Aug 14.
Dilatation of left atrium (LA) reflects chronic LA pressure or volume overload that possesses considerable prognostic information. Little is known regarding the interaction between LA remodeling after acute myocardial infarction (MI) and left atrial pressure at rest and during exercise. The objective was to assess changes in LA volume early after MI in patients with diastolic dysfunction and the relation to invasive hemodynamics and natriuretic peptides.
62 patients with left ventricle ejection fraction (LVEF)≥45%, diastolic E/e'>8 and LA volume index >34ml/m within 48h of MI were enrolled. After 1 and 4months blood sampling, echocardiography and right heart catheterization were performed during exercise test.
LA remodeling was considered in patients with a change from mild (35-41ml/m), to severe (>48ml/m) dilatation after 4months (Found in 22 patients (35%)). Patients with LA remodeling were characterized by lower a' (1month 8.9±2.0 vs. 10.4±2.5cm/s, p=0.002; 4month 8.8±2.0 vs. 10.4±2.4cm/s, p=0.007) and higher MR-proANP (1month 162±64 vs. 120±44pg/l, p=0.005; 4months 175±48 vs. 129±56pg/l, p=0.002). With exercise, pulmonary artery pressure, right atrial pressure and pulmonary capillary wedge pressure increased markedly in all patients. There were however, no significant differences in filling pressure at rest or during exercise irrespective of whether LA remodeling occurred.
Contrary to our hypothesis early LA dilatation after MI was weakly associated with resting and exercise induced changes in LA pressure overload. The dilatation was however associated with lower e' and higher MR-proANP.
左心房（LA）扩张反映了慢性左心房压力或容量超负荷，具有重要的预后信息。关于急性心肌梗死（MI）后左心房重构与静息及运动时左心房压力之间的相互作用，目前所知甚少。目的是评估舒张功能障碍患者心肌梗死后早期左心房容积的变化及其与有创血流动力学和利钠肽的关系。
纳入62例心肌梗死后48小时内左心室射血分数（LVEF）≥45%、舒张期E/e'>8且左心房容积指数>34ml/m²的患者。在1个月和4个月时进行血样采集，并在运动试验期间进行超声心动图和右心导管检查。
4个月后左心房容积从轻度（35 - 41ml/m²）变为重度（>48ml/m²）扩张的患者被认为存在左心房重构（22例患者（35%）出现这种情况）。发生左心房重构的患者表现为a'较低（1个月时8.9±2.0 vs. 10.4±2.5cm/s，p = 0. 002；4个月时8.8±2.0 vs. 10.4±2.4cm/s，p = 0.007）以及MR-proANP较高（1个月时162±64 vs. 120±44pg/l，p = 0.005；4个月时175±48 vs. 129±56pg/l，p = 0.002）。运动时，所有患者的肺动脉压、右心房压和肺毛细血管楔压均显著升高。然而，无论是否发生左心房重构，静息或运动时的充盈压均无显著差异。
与我们的假设相反，心肌梗死后早期左心房扩张与静息及运动诱发的左心房压力超负荷变化之间的关联较弱。然而，这种扩张与较低的e'和较高的MR-proANP相关。
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