右心房扩大可预测肺动脉高压患者临床上显著的室上性心律失常。
Right atrium enlargement predicts clinically significant supraventricular arrhythmia in patients with pulmonary arterial hypertension.
作者信息
Waligóra Marcin, Tyrka Anna, Miszalski-Jamka Tomasz, Urbańczyk-Zawadzka Małgorzata, Podolec Piotr, Kopeć Grzegorz
机构信息
Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Pradnicka 80, Kraków, Poland.
Department of Radiology and Diagnostic Imaging, John Paul II Hospital in Krakow, Pradnicka 80, Kraków, Poland.
出版信息
Heart Lung. 2018 May-Jun;47(3):237-242. doi: 10.1016/j.hrtlng.2018.01.004. Epub 2018 Feb 14.
BACKGROUND
Right atrial (RA) enlargement is a common finding in patients with pulmonary arterial hypertension (PAH) and an important predictor of mortality, however its relation to the risk of atrial arrhythmias has not been assessed.
OBJECTIVES
To assess whether RA enlargement is associated with supraventricular arrhythmias (SVA) and whether it predicts new clinically significant SVA (csSVA).
METHODS
Patients with PAH were recruited between January 2010 and December 2014 and followed until January 2017. csSVA was diagnosed if it resulted in hospitalization. To assess predictors of new csSVA, only patients without a history of SVA at baseline were analyzed.
RESULTS
Among 97 patients, any SVA was observed in 45 (46.4%) and included permanent atrial fibrillation(AF, n = 8), paroxysmal AF (n = 10), permanent atrial flutter (AFl, n = 1), paroxysmal AFl (n = 2) or other types of supraventricular tachycardia (n = 24). Patients with SVA as compared to patients without SVA were characterized by older age, lower distance in a 6-minute test, higher NT-proBNP, higher RA area index (RAai), left atrial area index, mean right atrial pressure (mRAP) and were more commonly treated with β-blocker. Eighty five patients who were in sinus rhythm at baseline assessment and had no history of significant SVA were observed for 37 ± 19.9 months. During that time csSVA occurred in 15.3%. In univariate models, the occurrence of csSVA were predicted by age, right ventricular ejection fraction, right ventricular end diastolic index, RAai and mRAP, but in multivariate model only RAai remained significant predictor for csSVA (HR of 1.23, 95%CI: 1.11-1.36, p < 0.001). The optimal threshold for RA enlargement as discriminator of csSVA was 21.7 cm2/m2.
CONCLUSIONS
In PAH patients RA enlargement is associated with increased prevalence of SVA. RAai is an independent predictor of hospitalization due to csSVA.
背景
右心房（RA）扩大是肺动脉高压（PAH）患者的常见表现，也是死亡率的重要预测指标，然而其与房性心律失常风险的关系尚未得到评估。
目的
评估RA扩大是否与室上性心律失常（SVA）相关，以及它是否能预测新出现的具有临床意义的SVA（csSVA）。
方法
2010年1月至2014年12月招募PAH患者，并随访至2017年1月。如果csSVA导致住院，则诊断为csSVA。为了评估新出现的csSVA的预测因素，仅分析基线时无SVA病史的患者。
结果
97例患者中，45例（46.4%）观察到任何SVA，包括永久性心房颤动（AF，n = 8）、阵发性AF（n = 10）、永久性心房扑动（AFl，n = 1）、阵发性AFl（n = 2）或其他类型的室上性心动过速（n = 24）。与无SVA的患者相比，有SVA的患者具有年龄较大、6分钟试验距离较短、NT-proBNP较高、RA面积指数（RAai）较高、左心房面积指数较高、平均右心房压力（mRAP）较高的特点，并且更常接受β受体阻滞剂治疗。对85例在基线评估时为窦性心律且无显著SVA病史的患者进行了37±19.9个月的观察。在此期间，15.3%的患者发生了csSVA。在单变量模型中，csSVA的发生可通过年龄、右心室射血分数、右心室舒张末期指数、RAai和mRAP预测，但在多变量模型中，只有RAai仍然是csSVA的显著预测因素（HR为1.23，95%CI：1.11-1.36，p < 0.001）。RA扩大作为csSVA鉴别指标的最佳阈值为21.7 cm2/m2。
结论
在PAH患者中，RA扩大与SVA患病率增加相关。RAai是csSVA导致住院的独立预测因素。
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