Abou Rachid, Leung Melissa, Tonsbeek Anthony M, Podlesnikar Tomaz, Maan Arie C, Schalij Martin J, Ajmone Marsan Nina, Delgado Victoria, Bax Jeroen J
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Am J Cardiol. 2017 Jul 1;120(1):140-147. doi: 10.1016/j.amjcard.2017.03.243. Epub 2017 Apr 12.
Aging is associated with changes in left atrial (LA) structure and function. The present study aimed at describing the effect of aging on LA properties in a large cohort of subjects without structural heart disease. We divided 386 subjects (mean age 58 years [range 16 to 91]; 188 men [49%]) clinically referred for echocardiography according to age groups. The P-wave dispersion (PWD), reflecting total atrial conduction time, was measured on a 12-lead surface electrocardiogram as the difference between maximum and minimum P-wave duration. The PA-TDI duration reflecting the total atrial conduction time was measured on tissue Doppler imaging (TDI) as the time between onset of P wave on surface electrocardiogram to peak A'-wave velocity. Two-dimensional speckle-tracking echocardiography was used to assess LA reservoir function, reflecting LA compliance. In the overall population, mean PWD, PA-TDI, and LA reservoir strain were 43 ± 12 ms, 129 ± 27 ms, and 36 ± 13%, respectively. Increasing age was independently associated with prolonged PWD (β = 0.161; p <0.001), PA-TDI (β = 0.476; p <0.001), and reduced LA reservoir strain (β = -0.259; <0.001), suggesting age-related fibrotic changes of the LA myocardium. The association between age and LA reservoir strain was modulated by body mass index (β = -0.582; p <0.001) and LA volume index (β = -0.117; p = 0.014). In conclusion, aging is associated with longer PWD and PA-TDI duration along with a decrease in LA reservoir function. Obesity and larger LA volumes are independently associated with reduced LA compliance.
衰老与左心房（LA）结构和功能的变化相关。本研究旨在描述衰老对一大群无结构性心脏病受试者左心房特性的影响。我们根据年龄组将386名临床转诊进行超声心动图检查的受试者（平均年龄58岁[范围16至91岁]；188名男性[49%]）进行了划分。反映全心房传导时间的P波离散度（PWD）在12导联体表心电图上测量，为最大和最小P波时限之差。反映全心房传导时间的PA-TDI时限在组织多普勒成像（TDI）上测量，为体表心电图上P波起始至A'波峰值速度之间的时间。二维斑点追踪超声心动图用于评估左心房储备功能，反映左心房顺应性。在总体人群中，平均PWD、PA-TDI和左心房储备应变分别为43±12毫秒、129±27毫秒和36±13%。年龄增长与PWD延长（β=0.161；p<0.001）、PA-TDI延长（β=0.476；p<0.001）以及左心房储备应变降低（β=-0.259；<0.001）独立相关，提示左心房心肌存在与年龄相关的纤维化改变。年龄与左心房储备应变之间的关联受体重指数（β=-0.582；p<0.001）和左心房容积指数（β=-0.117；p=0.014）调节。总之，衰老与更长的PWD和PA-TDI时限以及左心房储备功能降低相关。肥胖和更大的左心房容积与左心房顺应性降低独立相关。
