Yamaura Gensai, Watanabe Tetsu, Tamura Harutoshi, Tsuchiya Hayato, Hashimoto Naoto, Wanezaki Masahiro, Nishiyama Satoshi, Arimoto Takanori, Takahashi Hiroki, Yamauchi So, Shishido Tetsuro, Yamanaka Tamon, Miyamoto Takuya, Watanabe Masafumi
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
Heart Vessels. 2019 Nov;34(11):1769-1776. doi: 10.1007/s00380-019-01416-y. Epub 2019 Apr 26.
Prolonged total atrial conduction time is caused by atrial remodeling. Left atrial remodeling is associated with poor outcome in patients with heart failure (HF). This study aimed to investigate whether prolonged total atrial conduction time predicts poor prognosis in patients with HF. We performed transthoracic echocardiography in 100 patients (65 men; mean age 68 ± 13 years) who were hospitalized for HF. Total atrial conduction time was defined as the duration from P wave onset on electrocardiography to peak A' wave on tissue Doppler imaging (TDI) echocardiography (PA-TDI duration). There were 37 cardiac events (37%) during a median follow-up period of 414 days. The PATDI duration was significantly longer in patients with cardiac events than in those without (150 ± 18 ms vs 133 ± 19 ms; P < 0.05). There were no significant differences in left ventricular end-diastolic dimensions and ejection fractions between patients with and without cardiac events. Patients with HF were divided into 3 groups according to tertiles of the PA-TDI duration. Kaplan-Meier analysis showed that the highest tertile of PA-TDI duration was associated with the greatest risk among patients with HF. Multivariate Cox proportional hazard analysis showed that the PA-TDI duration was an independent predictor of cardiac events, leading to the conclusion that prolonged PA-TDI duration was a feasible predictor of cardiac prognosis in patients with HF.
总心房传导时间延长是由心房重构引起的。左心房重构与心力衰竭（HF）患者的不良预后相关。本研究旨在探讨总心房传导时间延长是否可预测HF患者的不良预后。我们对100例因HF住院的患者（65例男性；平均年龄68±13岁）进行了经胸超声心动图检查。总心房传导时间定义为心电图上P波起始至组织多普勒成像（TDI）超声心动图上A'波峰值的持续时间（PA-TDI持续时间）。在中位随访期414天内发生了37次心脏事件（37%）。发生心脏事件的患者的PATDI持续时间显著长于未发生心脏事件的患者（150±18毫秒对133±19毫秒；P<0.05）。发生和未发生心脏事件的患者之间左心室舒张末期内径和射血分数无显著差异。根据PA-TDI持续时间的三分位数将HF患者分为3组。Kaplan-Meier分析显示，PA-TDI持续时间最高的三分位数与HF患者中最大的风险相关。多变量Cox比例风险分析显示，PA-TDI持续时间是心脏事件的独立预测因子，从而得出结论：PA-TDI持续时间延长是HF患者心脏预后的可行预测指标。
