Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan.
Department of Clinical Laboratory The University of Tokyo Tokyo Japan.
J Am Heart Assoc. 2023 Sep 19;12(18):e030325. doi: 10.1161/JAHA.123.030325. Epub 2023 Sep 13.
Background Elevated left atrial (LA) pressure predisposes individuals to the initiation and persistence of atrial fibrillation (AF), and LA hypertension is associated with AF recurrence after catheter ablation (CA). However, the exact frequency and factors associated with LA hypertension are unknown, and its noninvasive estimation is challenging. This study aimed to investigate the prevalence and determinants of LA hypertension in patients with AF who underwent first CA. Methods and Results We examined 183 patients with AF who underwent conventional and speckle-tracking echocardiography before CA to assess LA size, reservoir strain, and stiffness. Direct LA pressure was measured at the time of CA, and LA hypertension was defined as mean LA pressure >15 mm Hg. Thirty-three (18.0%) patients exhibited LA hypertension. Patients with LA hypertension had a significantly larger LA volume index (40.2 [28.4-52.1] versus 34.1 [26.9-42.4] mL/m, =0.025), reduced LA reservoir strain (15.1 [10.4-21.7] versus 22.7 [14.4-32.3] %, =0.002) and increased LA stiffness (0.69 [0.34-0.99] versus 0.36 [0.24-0.54], <0.001). Multivariable analyses showed that waist circumference, C-reactive protein level, LA reservoir strain, and LA stiffness were independently associated with LA hypertension (all <0.05), while LA volume and E/e' ratio were not. Among echocardiographic parameters, receiver operating characteristic curve analysis identified LA stiffness as the best predictor of LA hypertension. Conclusions Approximately 20% of patients with AF who underwent CA had LA hypertension. Central obesity and inflammation might be involved in the pathophysiological mechanisms of LA hypertension, and echocardiography-derived LA stiffness may have clinical utility for the detection of LA hypertension before CA.
升高的左心房（LA）压力使个体易于发生和持续心房颤动（AF），并且 LA 高血压与导管消融（CA）后 AF 复发相关。然而，确切的 LA 高血压的频率和相关因素尚不清楚，其无创估计具有挑战性。本研究旨在调查接受首次 CA 的 AF 患者中 LA 高血压的患病率和决定因素。
我们检查了 183 例接受 CA 前常规和斑点追踪超声心动图检查的 AF 患者，以评估 LA 大小、储备应变和僵硬度。在 CA 时直接测量 LA 压力，并将 LA 高血压定义为平均 LA 压力>15mmHg。33 例（18.0%）患者出现 LA 高血压。LA 高血压患者的 LA 容积指数明显更大（40.2[28.4-52.1]vs. 34.1[26.9-42.4]mL/m2，=0.025），LA 储备应变降低（15.1[10.4-21.7]%vs. 22.7[14.4-32.3]%，=0.002），LA 僵硬度增加（0.69[0.34-0.99]vs. 0.36[0.24-0.54]，<0.001）。多变量分析显示，腰围、C 反应蛋白水平、LA 储备应变和 LA 僵硬度与 LA 高血压独立相关（均<0.05），而 LA 容积和 E/e' 比值则不然。在超声心动图参数中，ROC 曲线分析确定 LA 僵硬度是 LA 高血压的最佳预测因子。
约 20%接受 CA 的 AF 患者存在 LA 高血压。中心性肥胖和炎症可能参与 LA 高血压的病理生理机制，超声心动图衍生的 LA 僵硬度可能对 CA 前 LA 高血压的检测具有临床实用性。
