Almodares Qays, Wallentin Guron Cecilia, Thurin Anders, Fu Michael, Kontogeorgos Silvana, Thunstrom Erik, Johansson Magnus C
Department of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Echocardiography. 2017 May;34(5):662-667. doi: 10.1111/echo.13500. Epub 2017 Mar 14.
While left atrial (LA) enlargement is known as an early sign of left heart disease with prognostic implications in heart failure (HF), the importance of right atrial (RA) enlargement is less well studied, and the prognostic implications of interatrial size comparison are insufficiently understood. The aim of this study was to test the hypothesis that RA area larger than LA area in apical four-chamber view is associated with all-cause mortality in elderly patients with HF independent of left ventricular ejection fraction (LVEF).
Retrospectively, 289 patients above 65 years hospitalized for HF between April 2007 and April 2008, and who underwent an echocardiogram, were enrolled. All-cause mortality was registered during a follow-up of at least 56 months. Baseline parameters measured were RA area, LA area, LA volume, LVEF, left ventricular mass (LVM), tissue Doppler systolic velocity of right ventricular free wall (SmRV), presence of severe tricuspid regurgitation (TR), tricuspid gradient, central venous pressure, systolic pulmonary artery pressure, as well as some parameters of diastolic function.
In univariate analysis RA larger than LA was associated with all-cause mortality (hazard ratio [HR] of 1.88, P<.001). The relation of RA larger than LA to all-cause mortality remained even after adjusting for age, heart rate, LVEF, atrial fibrillation, percutaneous coronary intervention, LVM index, LA volume index, SmRV, and the presence of severe TR (HR: 1.79, P=.04).
RA larger than LA, independently of LVEF, is associated with all-cause mortality in elderly patients hospitalized due to HF.
虽然左心房（LA）扩大是左心疾病的早期迹象，对心力衰竭（HF）的预后有影响，但右心房（RA）扩大的重要性研究较少，房间大小比较的预后意义也未得到充分理解。本研究的目的是检验以下假设：在老年HF患者中，心尖四腔视图中RA面积大于LA面积与全因死亡率相关，且独立于左心室射血分数（LVEF）。
回顾性纳入2007年4月至2008年4月期间因HF住院且年龄在65岁以上并接受超声心动图检查的289例患者。在至少56个月的随访期间记录全因死亡率。测量的基线参数包括RA面积、LA面积、LA容积、LVEF、左心室质量（LVM）、右心室游离壁组织多普勒收缩速度（SmRV）、严重三尖瓣反流（TR）的存在情况、三尖瓣梯度、中心静脉压、收缩期肺动脉压以及一些舒张功能参数。
在单变量分析中，RA大于LA与全因死亡率相关（风险比[HR]为1.88，P<0.001）。即使在调整年龄、心率、LVEF、心房颤动、经皮冠状动脉介入治疗、LVM指数、LA容积指数、SmRV和严重TR的存在情况后，RA大于LA与全因死亡率的关系仍然存在（HR：1.79，P = 0.04）。
在因HF住院的老年患者中，RA大于LA且独立于LVEF与全因死亡率相关。
