Floria Mariana, Jamart Jacques, Schroeder Erwin, Georgesu Catalina Arsenescu
III Medical Clinic of University Hospital "Sf. Spiridon"; University of Medicine and Pharmacy "Gr. T. Popa"; University of Medicine and Pharmacy "Gr. T. Popa".
CHU Mont-Godinne, Catholic University of Louvain, Yvoir, Belgium.
J Atr Fibrillation. 2014 Dec 31;7(4):1159. doi: 10.4022/jafib.1159. eCollection 2014 Dec.
Left atrial (LA) dilation can evolve into asymmetrical remodeling. The aim of this study was to determine the echocardiographic parameters associated with LA asymmetric structural remodeling (ASR) in patients with and without nonvalvular atrial fibrillation (AF).
A total of 170 patients with a dilated LA were prospectively enrolled. ASR was defined as an atrium shape that is no longer ellipsoidal (LA basal dimension measured at the junction between the pulmonary vein and atrium greater than the mitral annular dimension). Symmetric structural remodeling (SSR) was defined as all other cases. Echocardiographic parameters of LA function and left ventricular diastolic function, measured by pulsed-wave Doppler and Tissue Doppler Imaging, were analyzed to identify the parameters associated with ASR. The mean age of the patients was 67 ± 11 years. Forty-one percent had a stable sinus rhythm (SR), and 59% had AF. LA-ASR was detected in 66% of the patients: 55% with AF and 45% with SR (p=0.002). The mean LA-ASR and LA-SSR volume indexes were 49 ± 14 ml/m² and 29 ± 13 ml/m², respectively (p<0.001). LA systolic myocardial velocity (p=0.036) and peak systolic pulmonary venous flow velocity (p=0.033) were the parameters best associated with ASR. The sensitivity and specificity of both parameters, based on ROC curve analysis, were 77 and 70%, respectively. The AUC was 0.765 (95% CI: 0.662-0.849, p=0.0001).
LA dilation is associated with a great number of asymmetrical structural remodeling. Echocardiographic parameters that reflect LA reservoir function are best associated with asymmetrical remodeling.
左心房（LA）扩张可演变为不对称重塑。本研究的目的是确定非瓣膜性心房颤动（AF）患者和非AF患者中与LA不对称结构重塑（ASR）相关的超声心动图参数。
前瞻性纳入170例LA扩张患者。ASR定义为心房形状不再呈椭圆形（在肺静脉与心房交界处测量的LA基底尺寸大于二尖瓣环尺寸）。对称结构重塑（SSR）定义为所有其他情况。通过脉冲波多普勒和组织多普勒成像测量LA功能和左心室舒张功能的超声心动图参数，以确定与ASR相关的参数。患者的平均年龄为67±11岁。41%为稳定窦性心律（SR），59%为AF。66%的患者检测到LA-ASR：AF患者中为55%，SR患者中为45%（p=0.002）。LA-ASR和LA-SSR的平均容积指数分别为49±14ml/m²和29±13ml/m²（p<0.001）。LA收缩期心肌速度（p=0.036）和收缩期肺静脉血流峰值速度（p=0.033）是与ASR最相关的参数。基于ROC曲线分析，这两个参数的敏感性和特异性分别为77%和70%。AUC为0.765（95%CI：0.662-0.849，p=0.0001）。
LA扩张与大量不对称结构重塑相关。反映LA储存功能的超声心动图参数与不对称重塑最相关。
