Mizuno R, Fujimoto S, Nakano H, Nakajima T, Kimura A, Nakagawa Y, Dohi K
First Department of Internal Medicine, Nara Medical University, Japan.
Eur Heart J. 1997 Dec;18(12):1995-2001. doi: 10.1093/oxfordjournals.eurheartj.a015211.
Atrial abnormalities in patients with progressive systemic sclerosis have not been evaluated in terms of intra-atrial conduction. We hypothesized that a delay in atrial conduction in these patients might produce diastolic abnormalities as well as atrial arrhythmias.
To evaluate the atrial function of patients with progressive systemic sclerosis by using echocardiography to measure the intra-atrial electromechanical activation coupling interval.
Twenty patients with progressive systemic sclerosis were assessed by Doppler echocardiography. Twenty age-matched healthy controls were also evaluated. Two-dimensional guided M-modes of ventricular long axes were recorded using simultaneous phono- and electrocardiograms of the apical four chamber view at the right lateral, septal and left lateral sites of the atrioventricular rings. Transmitral and tricuspid pulsed Doppler flow velocities were also recorded. Filtered P wave duration was measured on the signal averaged ECG to determine the duration of atrial electrical activation.
There was a delay in P on the electrocardiogram (P) at the onset of atrial contraction on long axis M-modes at all three atrioventricular ring sites in patients with progressive systemic sclerosis as compared with controls (P-right; 56 +/- 13 vs 47 +/- 10 ms, P-septal; 74 +/- 14 vs 55 +/- 10 ms, and P-lateral; 93 +/- 16 vs 72 +/- 11 ms, P < 0.01). Inter-atrial conduction time [(P-lateral)-(P-right)] was delayed in patients with progressive systemic sclerosis, compared with healthy controls (37 +/- 15 vs 25 +/- 6 ms, P < 0.01). Mitral A waves acceleration and deceleration times were also decreased in the patients. The interval was prolonged between P to the onset and the peak of the A wave in transmitral flow. Duration of the filtered P wave was significantly prolonged in progressive systemic sclerosis as compared with controls (124 +/- 12 ms vs 106 +/- 8 ms, P < 0.01). PQ intervals, E waves and acceleration and deceleration times did not differ significantly in progressive systemic sclerosis vs, controls. The A wave acceleration rate on transmitral flow (peak A wave velocity/acceleration time) showed a significant correlation with inter-atrial conduction delay (r = 0.55, P < 0.01).
Intra-atrial electromechanical coupling intervals were delayed in patients with progressive systemic sclerosis. Thus, the mechanical late diastolic filling time due to atrial contraction in the total diastolic phase was severely limited, and this resulted in a restricted mitral A wave. We should therefore evaluate patients with progressive systemic sclerosis for significant atrial abnormalities.
尚未从心房内传导方面评估进行性系统性硬化症患者的心房异常情况。我们推测这些患者的心房传导延迟可能会导致舒张功能异常以及房性心律失常。
通过超声心动图测量心房内机电激活耦合间期，以评估进行性系统性硬化症患者的心房功能。
对20例进行性系统性硬化症患者进行多普勒超声心动图评估。还评估了20名年龄匹配的健康对照者。在房室环的右外侧、间隔和左外侧部位，使用心尖四腔视图的同步心音图和心电图记录心室长轴的二维引导M型。还记录了二尖瓣和三尖瓣脉冲多普勒血流速度。在信号平均心电图上测量滤波后的P波持续时间，以确定心房电激活的持续时间。
与对照组相比，进行性系统性硬化症患者在所有三个房室环部位的长轴M型上，心房收缩开始时心电图上的P波出现延迟（右P波；56±13 vs 47±10毫秒，间隔P波；74±14 vs 55±10毫秒，左外侧P波；93±16 vs 72±11毫秒，P＜０.０１）。与健康对照组相比，进行性系统性硬化症患者的心房间传导时间[（左外侧P波） - （右P波）]延迟（37±15 vs 25±6毫秒，P＜０.０１）。患者的二尖瓣A波加速和减速时间也缩短。二尖瓣血流中从P波开始到A波峰值之间的间期延长。与对照组相比 ，进行性系统性硬化症患者滤波后的P波持续时间显著延长（124±12毫秒 vs 106±8毫秒，P＜０.０１）。进行性系统性硬化症患者与对照组相比，PQ间期、E波以及加速和减速时间无显著差异。二尖瓣血流的A波加速率（A波峰值速度/加速时间）与心房间传导延迟显著相关（r = 0.55，P＜０.０１）。
进行性系统性硬化症患者的心房内机电耦合间期延迟。因此，在整个舒张期由于心房收缩导致的机械性舒张晚期充盈时间严重受限，这导致二尖瓣A波受限。因此，我们应该评估进行性系统性硬化症患者是否存在明显的心房异常。
