成人主动脉缩窄修复术后左心房逆向重构的决定因素及其预后意义。
Determinants and prognostic implications of left atrial reverse remodelling after coarctation of aorta repair in adults.
机构信息
Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
出版信息
Eur Heart J Cardiovasc Imaging. 2024 Jan 29;25(2):249-256. doi: 10.1093/ehjci/jead203.
AIMS
Left atrial (LA) dysfunction and atrial fibrillation are also relatively common in adults with coarctation of aorta (COA), and the severity of LA dysfunction is associated with a higher risk of atrial fibrillation in this population. The purpose of this study was to determine whether LA function improved after COA repair (LA reverse remodelling), and the relationship between LA reverse remodelling and atrial fibrillation.
METHODS AND RESULTS
Retrospective cohort study of adults undergoing COA repair (2003-20). LA reservoir strain was assessed pre intervention and 12-24 months post intervention, using speckle tracking echocardiography. Incident atrial fibrillation was assessed from COA repair to last follow-up. Of 261 adults who underwent COA repair [age 37 ± 13 years; males 148 (57%)], 124 (47%) and 137 (53%) presented with native vs. recurrent COA, respectively. Of 261 patients, 231 (82%) and 48 (18%) underwent surgical and transcatheter COA repair, respectively. The LA reservoir strain increased from 32 ± 8% (pre intervention) to 39 ± 7% (post intervention), yielding a relative increase of 21 ± 5%. Older age [β ± standard error (SE) -0.16 ± 0.09 per 5 years, P = 0.02], higher systolic blood pressure (β ± SE -0.12 ± 0.04 per 5 mmHg, P = 0.005), and higher residual COA mean gradient (β ± SE -0.17 ± 0.06 per 5 mmHg, P = 0.002) post intervention were associated with less LA reverse remodelling, after adjustment for sex, hypertension diagnosis, and left ventricular indices. LA reverse remodelling (hazard ratio 0.97, 95% confidence interval 0.96-0.98 per 1% increase from pre-intervention LA function, P = 0.006) was associated with a lower risk of atrial fibrillation after adjustment for age, sex, pre-intervention LA reservoir strain, and history of atrial fibrillation.
CONCLUSION
COA repair resulted in improved LA function and decreased risk for atrial fibrillation, especially in patients without residual hypertension or significant residual COA gradient.
目的
左心房（LA）功能障碍和心房颤动在主动脉缩窄（COA）成人中也较为常见，LA 功能障碍的严重程度与该人群心房颤动的风险增加相关。本研究旨在确定 COA 修复后（LA 逆重构）LA 功能是否得到改善，以及 LA 逆重构与心房颤动之间的关系。
方法和结果
这是一项回顾性队列研究，纳入了 2003 年至 2020 年间接受 COA 修复的成年人。使用斑点追踪超声心动图评估 LA 储备应变，分别在干预前和干预后 12-24 个月进行。从 COA 修复到最后一次随访期间，评估新发心房颤动。在 261 名接受 COA 修复的成年人中（年龄 37 ± 13 岁；男性 148 名[57%]），分别有 124 名（47%）和 137 名（53%）患者存在原发性和复发性 COA。在 261 名患者中，分别有 231 名（82%）和 48 名（18%）接受了手术和经导管 COA 修复。LA 储备应变从 32 ± 8%（干预前）增加到 39 ± 7%（干预后），相对增加 21 ± 5%。年龄较大（每 5 岁增加-0.16 ± 0.09，P = 0.02）、收缩压较高（每 5mmHg 增加-0.12 ± 0.04，P = 0.005）和残余 COA 平均梯度较高（每 5mmHg 增加-0.17 ± 0.06，P = 0.002）与 LA 逆重构减少相关，在调整性别、高血压诊断和左心室指数后。LA 逆重构（风险比 0.97，95%置信区间 0.96-0.98，每增加 1%来自干预前 LA 功能，P = 0.006）与心房颤动风险降低相关，在调整年龄、性别、干预前 LA 储备应变和心房颤动史后。
结论
COA 修复可改善 LA 功能并降低心房颤动的风险，尤其是在无残余高血压或明显残余 COA 梯度的患者中。
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