Hrabia Joanna B, Pogue Elahn P L, Zayachkowski Alexander G, Długosz Dorota, Kruszelnicka Olga, Surdacki Andrzej, Chyrchel Bernadeta
Students' Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Department of Coronary Artery Disease and Heart Failure, The John Paul II Memorial Specialist Hospital, Krakow, Poland.
Postepy Kardiol Interwencyjnej. 2018;14(2):120-127. doi: 10.5114/aic.2018.76402. Epub 2018 Jun 19.
In the assessment of cardiovascular disease, the clinical significance of left atrial (LA) pressure-volume relations has largely been overlooked in contrast to left ventricular (LV) compliance. However, LA compliance has recently gained more attention. Net atrioventricular compliance (), a joint measure of LA and LV compliance, can be calculated non-invasively by a previously validated method using parameters from standard echocardiography. Compliance measurement may be of relevance in selected clinical settings. First, subjects with low are more likely to have their mitral valve area overestimated by the traditional mitral pressure half-time method. Consequently, low in mitral stenosis, usually resulting from reduced LA compliance, can be mistaken for mild mitral stenosis. Second, low independently predicted pulmonary hypertension and disease progression in medically treated mitral stenosis, and late cardiovascular complications after successful percutaneous mitral valvuloplasty. Decreased LA compliance also accounts for stiff LA syndrome, a rare complication of radiofrequency catheter ablation for atrial fibrillation, manifesting as otherwise unexplained heart failure with elevated LA pressure and pulmonary hypertension. Finally, depressed pre-ablation LA stiffness index, i.e. the ratio of the change in LA pressure to the corresponding change in LA volume during passive LA filling, was an independent predictor of arrhythmia recurrence. Thus, LA stiffening translates into adverse clinical outcomes in patients with mitral stenosis or atrial fibrillation undergoing interventional procedures. Whether reduced LA compliance after LA appendage occlusion can result in the LA stiff syndrome, has not been reported so far.
在心血管疾病评估中，与左心室（LV）顺应性相比，左心房（LA）压力 - 容积关系的临床意义在很大程度上被忽视了。然而，LA顺应性最近受到了更多关注。房室净顺应性（）是LA和LV顺应性的联合指标，可以通过一种先前验证的方法，使用标准超声心动图参数进行无创计算。顺应性测量在某些临床情况下可能具有相关性。首先，房室净顺应性低的受试者更有可能被传统二尖瓣压力减半时间法高估二尖瓣面积。因此，二尖瓣狭窄时房室净顺应性低（通常是由于LA顺应性降低所致）可能被误诊为轻度二尖瓣狭窄。其次，房室净顺应性低独立预测药物治疗的二尖瓣狭窄患者的肺动脉高压和疾病进展，以及经皮二尖瓣球囊成形术成功后的晚期心血管并发症。LA顺应性降低也是僵硬LA综合征的原因，这是房颤射频导管消融术的一种罕见并发症，表现为原因不明的心力衰竭，伴有LA压力升高和肺动脉高压。最后，消融前LA僵硬度指数降低，即被动LA充盈期间LA压力变化与相应LA容积变化的比值，是心律失常复发的独立预测因素。因此，LA僵硬在接受介入手术的二尖瓣狭窄或房颤患者中会转化为不良临床结局。到目前为止，尚未有关于LA附件闭塞后LA顺应性降低是否会导致LA僵硬综合征的报道。
