心房颤动患者静息和应激状态下的左心房功能障碍
Rest and Stress Left Atrial Dysfunction in Patients with Atrial Fibrillation.
作者信息
Zagatina Angela, Rivadeneira Ruiz Maria, Ciampi Quirino, Wierzbowska-Drabik Karina, Kasprzak Jaroslaw, Kalinina Elena, Begidova Irina, Peteiro Jesus, Arbucci Rosina, Marconi Sofia, Lowenstein Jorge, Boshchenko Alla, Manganelli Fiore, Čelutkienė Jelena, Morrone Doralisa, Merli Elisa, Re Federica, Borguezan-Daros Clarissa, Haberka Maciej, Saad Ariel K, Djordjevic-Dikic Ana, Ratanasit Nithima Chaowalit, Rigo Fausto, Colonna Paolo, Pretto José Luis de Castro E Silva, Mori Fabio, D'Alfonso Maria Grazia, Ostojic Miodrag, Stanetic Bojan, Preradovic Tamara Kovacevic, Costantino Fabio, Barbieri Andrea, Citro Rodolfo, Pitino Annalisa, Pepi Mauro, Carerj Scipione, Pellikka Patricia A, Picano Eugenio
机构信息
Cardiology Department, Research Scientific Cardiocenter "Medika", 197110 St. Petersburg, Russia.
Cardiology Department, University Hospital of Virgen Macarena, 41009 Seville, Spain.
出版信息
J Clin Med. 2023 Sep 11;12(18):5893. doi: 10.3390/jcm12185893.
BACKGROUND
Left atrial (LA) myopathy with paroxysmal and permanent atrial fibrillation (AF) is frequent in chronic coronary syndromes (CCS) but sometimes occult at rest and elicited by stress.
AIM
This study sought to assess LA volume and function at rest and during stress across the spectrum of AF.
METHODS
In a prospective, multicenter, observational study design, we enrolled 3042 patients [age = 64 ± 12; 63.8% male] with known or suspected CCS: 2749 were in sinus rhythm (SR, Group 1); 191 in SR with a history of paroxysmal AF (Group 2); and 102 were in permanent AF (Group 3). All patients underwent stress echocardiography (SE). We measured left atrial volume index (LAVI) in all patients and LA Strain reservoir phase (LASr) in a subset of 486 patients.
RESULTS
LAVI increased from Group 1 to 3, both at rest (Group 1 = 27.6 ± 12.2, Group 2 = 31.6 ± 12.9, Group 3 = 43.3 ± 19.7 mL/m, < 0.001) and at peak stress (Group 1 = 26.2 ± 12.0, Group 2 = 31.2 ± 12.2, Group 3 = 43.9 ± 19.4 mL/m, < 0.001). LASr progressively decreased from Group 1 to 3, both at rest (Group 1 = 26.0 ± 8.5%, Group 2 = 23.2 ± 11.2%, Group 3 = 8.5 ± 6.5%, < 0.001) and at peak stress (Group 1 = 26.9 ± 10.1, Group 2 = 23.8 ± 11.0 Group 3 = 10.7 ± 8.1%, < 0.001). Stress B-lines (≥2) were more frequent in AF (Group 1 = 29.7% vs. Group 2 = 35.5% vs. Group 3 = 57.4%, < 0.001). Inducible ischemia was less frequent in SR (Group 1 = 16.1% vs. Group 2 = 24.7% vs. Group 3 = 24.5%, = 0.001).
CONCLUSIONS
In CCS, rest and stress LA dilation and reservoir dysfunction are often present in paroxysmal and, more so, in permanent AF and are associated with more frequent inducible ischemia and pulmonary congestion during stress.
背景
慢性冠状动脉综合征（CCS）患者中，伴有阵发性和永久性心房颤动（AF）的左心房（LA）肌病较为常见，但有时在静息状态下隐匿，在应激时出现。
目的
本研究旨在评估房颤各类型患者静息及应激状态下的左心房容积和功能。
方法
采用前瞻性、多中心、观察性研究设计，纳入3042例已知或疑似CCS患者[年龄=64±12岁；男性占63.8%]：2749例处于窦性心律（SR，第1组）；191例有阵发性房颤病史且处于SR（第2组）；102例处于永久性房颤（第3组）。所有患者均接受负荷超声心动图（SE）检查。我们测量了所有患者的左心房容积指数（LAVI），并在486例患者的亚组中测量了左心房应变储备期（LASr）。
结果
LAVI从第1组到第3组升高，在静息状态下（第1组=27.6±12.2，第2组=31.6±12.9，第3组=43.3±19.7 mL/m²，P<0.001）和应激峰值时（第1组=26.2±12.0，第2组=31.2±12.2，第3组=43.9±19.4 mL/m²，P<0.001）均如此。LASr从第1组到第3组逐渐降低，在静息状态下（第1组=26.0±8.5%，第组=23.2±11.2%，第3组=8.5±6.5%，P<0.001）和应激峰值时（第1组=26.9±10.1，第2组=23.8±11.0，第3组=10.7±8.1%，P<0.001）均如此。应激B线（≥2条）在房颤患者中更常见（第1组=29.7%，第2组=35.5%，第3组=57.4%，P<0.001）。SR患者中可诱导性缺血较少见（第1组=16.1%，第2组=24.7%，第3组=24.5%，P=0.001）。
结论
在CCS中，阵发性房颤尤其是永久性房颤常出现静息及应激状态下的左心房扩张和储备功能障碍，且与应激时更频繁的可诱导性缺血及肺充血相关。
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