Department of Advanced Medical Sciences, Federico II University of Naples, Italy; Hypertension Research Center, Federico II University of Naples, Italy.
Hypertension Research Center, Federico II University of Naples, Italy.
Int J Cardiol. 2018 Aug 15;265:229-233. doi: 10.1016/j.ijcard.2018.03.120. Epub 2018 Mar 27.
Left atrial (LA) volume is a predictor of outcome in hypertension. It is unclear whether or not this effect depends on coexisting target organ damage (TOD).
To investigate whether LA volume predicts outcome independently of TOD [left ventricular (LV) hypertrophy (LVH) and/or carotid plaque] in a registry of hypertensive treated patients.
From the Campania Salute Network registry, we selected 5844 young adult hypertensive patients <65 years old (mean age 50 ± 9 years, 41% women, 8% diabetic) without prevalent CV or valvular heart disease more than mild, with normal LV ejection fraction, stage III or less CKD and available follow-up. LA volume was estimated from LA diameter applying a validated nonlinear equation, and indexed to body height in meters to the second power (eLAVI). Composite fatal and non-fatal stroke, myocardial infarction, sudden cardiac death, heart failure, TIA, myocardial revascularization, de novo angina, carotid stenting or atrial fibrillation (AF) were adjudicated as incident CV events.
565 (10%) patients exhibited dilated initial eLAVI. During a median follow-up of 49 months, 233 patients developed CV events. Multivariable Cox regression analysis, demonstrated that dilated eLAVI increased risk of incident composite CV events (HR 1.90, 95%CI 1.26-2.88, p = 0.002), independently of significant effect of older age, male sex, presence LVH and carotid plaque. Conclusions In middle aged, treated hypertensive patients, dilated eLAVI is associated with adverse CV risk profile and is a predictor of CV events independently of other markers of TOD. LA dilatation should be considered as a TOD.
左心房（LA）容积是高血压患者预后的预测因素。尚不清楚这种影响是否依赖于并存的靶器官损伤（TOD）。
在接受治疗的高血压患者登记处，调查左心房容积是否独立于 TOD [左心室（LV）肥厚（LVH）和/或颈动脉斑块]预测结局。
我们从坎帕尼亚健康网络登记处中选择了 5844 名年龄<65 岁的年轻成年高血压患者（平均年龄 50±9 岁，41%为女性，8%为糖尿病患者），无明显 CV 疾病或中重度瓣膜性心脏病，左心室射血分数正常，CKD 分期为 3 期或以下，并且可获得随访。LA 容积通过 LA 直径应用经过验证的非线性方程进行估计，并根据身高（米）的平方进行指数化（eLAVI）。复合致死性和非致死性卒中、心肌梗死、心源性猝死、心力衰竭、短暂性脑缺血发作、血运重建、新发心绞痛、颈动脉支架置入术或心房颤动（AF）被判定为心血管事件。
565 例（10%）患者初始 eLAVI 增大。在中位随访 49 个月期间，233 例患者发生心血管事件。多变量 Cox 回归分析表明，增大的 eLAVI 增加了发生复合心血管事件的风险（HR 1.90，95%CI 1.26-2.88，p=0.002），与年龄较大、男性、LVH 和颈动脉斑块的显著作用无关。结论：在中年、接受治疗的高血压患者中，增大的 eLAVI 与不良 CV 风险特征相关，并且是心血管事件的独立预测因素，独立于其他 TOD 标志物。LA 扩张应被视为一种 TOD。
