Papadopoulos Christodoulos E, Pagourelias Efstathios, Bakogiannis Constantinos, Triantafyllou Konstantinos, Baltoumas Konstantinos, Kassimatis Efstratios, Zioutas Dimitrios, Siskos Dimitrios, Tzikas Stergios, Fragakis Nikolaos, Papagianni Aikaterini, Vassilikos Vassilios
3rd Cardiology Department, Hippokrateio University Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 43 Str, 54643, Thessaloniki, Greece.
Nephrology Department, Hippokrateio University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Int J Cardiovasc Imaging. 2018 Sep;34(9):1393-1401. doi: 10.1007/s10554-018-1353-x. Epub 2018 Apr 21.
It is widely known that various factors contribute to left atrial (LA) mechanical dysfunction in patients with end stage renal disease (ESRD). However, the connection between atrial dysfunction and arrhythmic events such as paroxysmal atrial fibrillation (PAF), in this group of patients, remains unclear. The purpose of our study was to evaluate prospectively the association between LA deformation indices and PAF in ESRD patients. 79 patients (41 men, mean age 57 ± 17) with ESRD and preserved left ventricular systolic function comprised the study population. All patients underwent a baseline comprehensive echocardiography study and were followed for a mean period of 16 ± 5 months. PAF episodes, first and the following events, were reported. LA longitudinal strain reflecting LA reservoir function and LA longitudinal strain rate reflecting LA pump function were specifically evaluated as LA deformation indices of interest, using 2D speckle tracking echocardiography. At the end of follow up period nine patients died. 15 of the rest 70 reported one or more episodes of PAF. LA indexed volumes were significantly higher in patients with PAF (32 ± 26 vs. 21.5 ± 9 ml/m, p = 0.002), mean LA strain was significantly reduced (17 ± 7 vs. 27 ± 9%, p < 0.001) as well as mean LA stain rate (- 1.19 ± 0.5 vs. - 1.95 ± 0.5 1/s, p < 0.001). Multivariate analysis showed that LA strain rate when adjusted with age together with PAF history remained the single most significant echocardiographic parameter for PAF prediction. Impaired LA strain and LA strain rate are associated with PAF in ESRD patients. LA strain rate might be a better independent predictor of PAF, compared to standard echocardiographic indices. Further prospective studies are needed to validate its relevance in routine clinical practice.
众所周知，多种因素可导致终末期肾病（ESRD）患者出现左心房（LA）机械功能障碍。然而，在这组患者中，心房功能障碍与心律失常事件（如阵发性心房颤动（PAF））之间的联系仍不明确。我们研究的目的是前瞻性评估ESRD患者左心房变形指数与PAF之间的关联。79例ESRD且左心室收缩功能保留的患者（41例男性，平均年龄57±17岁）构成了研究人群。所有患者均接受了基线综合超声心动图检查，并随访了平均16±5个月。记录了PAF发作情况，包括首次发作及后续发作。使用二维斑点追踪超声心动图，将反映左心房储存功能的左心房纵向应变和反映左心房泵功能的左心房纵向应变率作为感兴趣的左心房变形指数进行了专门评估。随访期末，9例患者死亡。其余70例中的15例报告了一次或多次PAF发作。PAF患者的左心房指数容积显著更高（32±26 vs. 21.5±9 ml/m，p = 0.002），平均左心房应变显著降低（17±7 vs. 27±9%，p < 0.001），平均左心房应变率也显著降低（-1.19±0.5 vs. -1.95±0.5 1/s，p < 0.001）。多变量分析显示，在根据年龄和PAF病史进行调整后，左心房应变率仍然是预测PAF的最显著超声心动图参数。左心房应变和应变率受损与ESRD患者的PAF相关。与标准超声心动图指标相比，左心房应变率可能是PAF更好的独立预测指标。需要进一步的前瞻性研究来验证其在常规临床实践中的相关性。
