Left Atrial Stiffness Relates to Left Ventricular Diastolic Dysfunction and Recurrence After Pulmonary Vein Isolation for Atrial Fibrillation
Left Atrial Stiffness Relates to Left Ventricular Diastolic Dysfunction and Recurrence After Pulmonary Vein Isolation for Atrial Fibrillation
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DOI：
10.1111/j.1540-8167.2011.02049.x
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发表时间：
2011-09-01
影响因子：
2.7
通讯作者：
Aonuma, Kazutaka
中科院分区：
文献类型：
--
作者：
Machino-Ohtsuka, Tomoko;Seo, Yoshihiro;Aonuma, Kazutaka
左心房僵硬和心房颤动。简介：左心房 (LA) 硬度增加反映了 LA 功能的结构重塑和恶化。本研究旨在通过测量房颤 (AF) 肺静脉隔离 (PVI) 患者的应变和 LA 压力来估计 LA 硬度，并评估 PVI 后 LA 硬度对心功能、血清标志物和 AF 复发的影响。方法：在 155 名连续 AF 患者中，在 PVI 前测量脑钠尿肽 (BNP) 和氨基末端前胶原 III 型前肽 (PIIIP) 血浆水平。通过房间隔穿刺直接测量最小和最大 LA 收缩压之间的差异。采用斑点追踪超声心动图评估的 LA 压力差与 LA 收缩峰值应变之比作为 LA 硬度的指标。 结果：计算出的 LA 硬度指数与 BNP 水平相关（r(s) = 0.444，P < 0.001）、E/E +/- 比率（r(s) = 0.444，P < 0.001）、LA 体积指数（r(s) = 0.370，P < 0.001）和 PIIIP 水平（r(s) = 0.305，P = 0.002）。在平均 33.8 +/- 12.2 个月的随访期间，45 名患者 (29%) 出现房颤复发。 Cox比例风险回归分析显示，LA僵硬度指数是AF复发的独立预测因子（HR 2.88；95% CI 1.75至4.73，P < 0.001）。结论：在AF患者中，LA僵硬度指数与左心室舒张功能障碍、LA扩张和胶原合成有关，可能预测PVI后AF复发。 （《心血管电生理杂志》，第 22 卷，第 999-1006 页，2011 年 9 月）
Left Atrial Stiffness and Atrial Fibrillation. Introduction: An increased left atrial (LA) stiffness reflects the structural remodeling and deterioration of the LA function. This study was designed to estimate LA stiffness by measuring a combination of the strain and LA pressure in patients undergoing pulmonary vein isolation (PVI) of atrial fibrillation (AF) and to evaluate the influence of the LA stiffness on the cardiac function, serum markers, and recurrence of AF after PVI.Methods: In 155 consecutive patients with AF, the brain natriuretic peptide (BNP) and aminoterminal procollagen type III propeptide (PIIIP) plasma levels were measured before the PVI. The difference between the minimum and maximum LA systolic pressures was directly measured by a transseptal puncture. The ratio of the difference in the LA pressures to the peak systolic LA strain evaluated by speckle-tracking echocardiography was used as an index of the LA stiffness.Results: The calculated LA stiffness index was related to the BNP level (r(s) = 0.444, P < 0.001), E/E +/- ratio (r(s) = 0.444, P < 0.001), LA volume index (r(s) = 0.370, P < 0.001), and PIIIP level (r(s) = 0.305, P = 0.002). During a mean follow-up period of 33.8 +/- 12.2 months, 45 patients (29%) presented with AF recurrences. A Cox proportional hazard regression analysis showed the LA stiffness index was an independent predictor of recurrence of AF (HR 2.88; 95% CI 1.75 to 4.73, P < 0.001).Conclusions: In patients with AF, the LA stiffness index is related to left ventricular diastolic dysfunction, LA dilatation, and collagen synthesis and may predict AF recurrences after PVI. (J Cardiovasc Electrophysiol, Vol. 22, pp. 999-1006, September 2011)