Barbier P, Alioto G, Guazzi M D
Istituto di Cardiologia, Università degli Studi, Milano, Italy.
J Am Coll Cardiol. 1994 Jul;24(1):165-70. doi: 10.1016/0735-1097(94)90558-4.
We evaluated left atrial dimensions and function, as well as left ventricular structure and filling, in hypertensive patients with paroxysmal atrial fibrillation.
In hypertensive patients, left atrial dilation and enhanced volume transport may facilitate arrhythmias.
Left ventricular two-dimensional and M-mode echocardiograms and pulsed Doppler echocardiography of transmitral flow were performed in 17 consecutive primary hypertensive patients with paroxysmal atrial fibrillation (group EHf) and in 34 patients with high blood pressure without this arrhythmia (group EH). Seventeen normal subjects (group N) were also investigated. Groups were matched for age and gender.
The EH and EHf groups had similar systolic arterial pressures ([mean +/- SD] group EH 185 +/- 27, group EHf 173 +/- 25 mm Hg, p = NS) and left ventricular mass index (group EH 154 +/- 55, group EHf 131 +/- 57.8 g/m2, p = NS), and their M-mode left ventricular systolic wall stress and fractional shortening were comparable to those of normal subjects. M-mode left atrial maximal (group N 37.8 +/- 6, group EH 37.9 +/- 4.6, group EHf 44.6 +/- 6.7 mm, p < 0.05 for group EHf vs. groups N and EH) and minimal diameters and the diameter preceding atrial contraction (group N 31 +/- 3.6, group EH 34.5 +/- 5, group EHf 40.4 +/- 6.9 mm, p < 0.001 for group EHf vs. group N; p < 0.05 for group EHf vs. group EH) were greater in group EHf than in group EH and group N subjects, whereas only the latter diameter was increased in group EH (p < 0.05 vs. group N), so that left atrial fractional shortening was higher than normal only in group EH (group N 10.8 +/- 4.4%, group EH 14.6 +/- 5.5%, group EHf 9.3 +/- 5.3%; group EH vs. group N, p < 0.05; group EHf vs. group EH, p < 0.05). The pulsed Doppler ratio of early to late transmitral flow rates (E and A wave velocity/time integrals x mitral annulus area) was lower than normal in group EH (group N 2.9 +/- 2.2, group EH 1.75 +/- 0.8, group EHf 2.8 +/- 0.8; group EH vs. group N, p < 0.05; group EHf vs. group EH, p < 0.001; group EHf vs. group N, p = NS) and was "normalized" in group EHf, early flow being increased in this group (group N 42 +/- 13, group EH 39 +/- 29, group EHf 60 +/- 17 ml; group EHf vs. group N, p < 0.05; group EHf vs. group EH, p < 0.05).
These results suggest that the occurrence of paroxysmal atrial fibrillation in hypertension is associated with enlargement of the left atrium, depression of its contractile function and "normalization" of the pattern of left ventricular filling and is independent of left ventricular hypertrophy and systolic wall stress. The mechanisms linking these variables remain undefined.
我们评估了阵发性心房颤动高血压患者的左心房大小和功能，以及左心室结构和充盈情况。
在高血压患者中，左心房扩张和容量运输增强可能促进心律失常。
对17例连续性原发性阵发性心房颤动高血压患者（EHf组）、34例无此心律失常的高血压患者（EH组）进行了左心室二维和M型超声心动图检查以及二尖瓣血流脉冲多普勒超声心动图检查。还对17名正常受试者（N组）进行了研究。各组在年龄和性别上相匹配。
EH组和EHf组的收缩动脉压相似（[均值±标准差]EH组185±27，EHf组173±25mmHg，p=无显著性差异），左心室质量指数也相似（EH组154±55，EHf组131±57.8g/m²，p=无显著性差异），且它们的M型左心室收缩壁应力和缩短分数与正常受试者相当。M型左心房最大直径（N组37.8±6，EH组37.9±4.6，EHf组44.6±6.7mm，EHf组与N组和EH组相比，p<0.05）、最小直径和心房收缩前直径（N组31±3.6，EH组34.5±5，EHf组40.4±6.9mm，EHf组与N组相比，p<0.001；EHf组与EH组相比，p<0.05）在EHf组大于EH组和N组受试者，而只有后者直径在EH组增加（与N组相比，p<0.05），因此只有EH组的左心房缩短分数高于正常（N组10.8±4.4%，EH组14.6±5.5%，EHf组9.3±5.3%；EH组与N组相比，p<0.05；EHf组与EH组相比，p<0.05）。二尖瓣血流早期与晚期流速的脉冲多普勒比值（E和A波速度/时间积分×二尖瓣环面积）在EH组低于正常（N组2.9±2.2，EH组1.75±0.8，EHf组2.8±0.8；EH组与N组相比，p<0.05；EHf组与EH组相比，p<0.001；EHf组与N组相比，p=无显著性差异），且在EHf组“正常化”，该组早期血流增加（N组42±13，EH组39±29，EHf组60±17ml；EHf组与N组相比，p<0.05；EHf组与EH组相比，p<0.05）。
这些结果表明，高血压患者阵发性心房颤动的发生与左心房扩大、其收缩功能降低以及左心室充盈模式“正常化”有关，且独立于左心室肥厚和收缩壁应力。这些变量之间的联系机制仍不明确。
