Left Atrial Morphology and Function: The Other Side of Cardiovascular Risk.
Left Atrial Morphology and Function: The Other Side of Cardiovascular Risk.
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左心房形态和功能：心血管风险的另一面。
DOI：
10.1161/circimaging.116.004494
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Homma,Shunichi
中科院分区：
文献类型：
--
作者：
DiTullio,MarcoR;Homma,Shunichi
2 Di Tullio和Homma左心房和心血管风险，称为舒张性心力衰竭或射血分数保留的心力衰竭），只有三分之一的病例存在中度舒张功能障碍，这一比例略高于高血压甚至健康个体。即便如此，与其他亚组相比，心力衰竭患者确实显示出显著的左心房扩张和左心房射血分数受损;然而，无法将心力衰竭和左心室射血分数保留的患者与其他患者分开。左心房容积和功能在收缩期和舒张期心力衰竭中可能受到不同的影响，特别是当考虑相位容积时。LA最小（舒张）容积已被证明与LV舒张功能障碍更密切相关，14鉴于二尖瓣打开时心房在二尖瓣关闭期间直接暴露于LV压力，这似乎是合理的。在Gonçalves等人的文章中，在整个研究组中，LA最小容积与LAEF密切相关，而当考虑相关协变量时，LA最大（收缩）容积与LAEF无关（表2）。在每个诊断亚组中，LA最小容积与LAEF的相关性最强，而LA最大容积仅在高血压患者中与LAEF相关，且程度低于最小容积（表3）。越来越多的证据表明，LA最小容量可能比传统使用的最大容量更能预测结果。LA最小容积已被证明是比最大容积更好的房性心律失常发展预测指标15，16;此外，LA最小容积已被证明比最大容积与脑磁共振成像检测到的亚临床脑血管疾病更密切相关，17提供了其作为结局更强预测指标的可能作用的初步指示。左心房相位容积的使用，尤其是除传统使用的最大容积外的最小容积，是Gonçalves等人的文章间接支持的重要方法学方面之一。本研究存在一些研究队列组成和研究设计固有的局限性，因此不可避免。研究队列的年龄较大，这既是一个优势，也是一个限制。如果，一方面，它允许在老年人，具有最高频率的危险因素和心脏异常和心力衰竭发展的风险最高的年龄组的感兴趣的变量的研究，另一方面，它阻止了年龄对变量的影响的充分评价。由于研究人群的人种-种族组成（85%为白色），可能无法将结果推广到少数民族代表性较大的人群，以及潜在不同的风险因素特征。更重要的是，正如作者提醒我们的那样，这是一项横断面研究，因此，在这种情况下，可以提示变量之间的关联，但不能建立因果关系，并提示但不能证明所检查的超声心动图参数对心血管疾病的预测价值。最后，新的诊断方法，如三维超声心动图的成功，将取决于它们能在多大程度上改善现有的诊断方法。具体而言，三维超声心动图已被证明比二维超声心动图更准确地确定左心房容积18 -20;挑战将是证明它在左心房容积方面也能更好地表现。
2 Di Tullio and Homma Left Atrium and Cardiovascular Risk known as diastolic heart failure or heart failure with preserved ejection fraction), moderate diastolic dysfunction was present in only one third of cases, a proportion that was slightly but not significantly higher than that observed in hypertensive or even healthy individuals. Even so, heart failure patients did show significant LA dilatation and LAEF impairment compared with the other subgroups; however, there was no possibility to separate patients with heart failure and preserved LV ejection fraction from others. LA volumes and function may be affected differently in systolic and diastolic heart failure, especially when phasic volumes are considered. LA minimum (diastolic) volume has been shown to be more strongly associated with LV diastolic dysfunction, 14 which seems reasonable given the fact that the atrium is directly exposed to the LV pressure during diastole, when the mitral valve is open. In Gonçalves et al’s article, LA minimum volume was strongly associated with LAEF in the entire study group, whereas LA maximum (systolic) volume was not associated with LAEF when pertinent covariates were taken into account (Table 2). LA minimum volume was the strongest correlate of LAEF in every diagnostic subgroup, whereas LA maximum volume was associated with LAEF only in hypertensive individuals and to a lesser degree than the minimum volume (Table 3). Evidence has been accumulating that LA minimum volume may be a better predictor of outcome than the traditionally used maximum volume. LA minimum volume has been shown to be a better predictor of the development of atrial arrhythmias than the maximum volume15, 16; also, LA minimum volume has been shown to be more strongly associated than maximum volume with subclinical cerebrovascular disease detected by brain magnetic resonance imaging, 17 providing an initial indication of its possible role as a stronger predictor of outcomes. The use of LA phasic volumes, and especially of the minimum volume in addition to the traditionally used maximum volume, is one of the important methodological aspects that the article by Gonçalves et al indirectly supports. The study has some limitations that are inherent to the composition of the study cohort and to the study design and are, therefore, unavoidable. The older age of the studied cohort is at the same time an advantage and a limitation. If, on one hand, it allows the study of the variables of interest in the elderly, the age group that has the highest frequency of risk factors and cardiac abnormalities and the highest risk of heart failure development, on the other hand, it prevents the full appreciation of the effects of age on the variables under examination. Because of the race-ethnic composition of the study population (85% white), the generalization of the results to populations with a larger representation of minorities, and potentially different risk factors profiles, may not be possible. More importantly, as the authors remind us, this is a cross-sectional study and is, therefore, in the condition to suggest associations between variables, but not to establish causality, and to suggest, but not prove, the predictive value of the examined echocardiographic parameters for cardiovascular disease. In the end, the success of newer diagnostic modalities, such as 3-dimensional echocardiography, will lie in how much they can improve on what is already available. In the specific, 3-dimensional echocardiography has been shown to be more accurate than 2-dimensional echocardiography for LA volume determination18–20; the challenge will be to demonstrate that it can also perform better in the …
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影响因子：
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作者：
Fatema, Kaniz;Barnes, Marion E.;Tsang, Teresa S. M.
通讯作者：
Tsang, Teresa S. M.
影响因子：
8.3
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LA体积和储层功能与亚临床脑血管疾病有关：CABL（心血管异常和脑病变）研究。
影响因子：
14
作者：
Russo, Cesare;Jin, Zhezhen;Liu, Rui;Iwata, Shinichi;Tugcu, Aylin;Yoshita, Mitsuhiro;Homma, Shunichi;Elkind, Mitchell S. V.;Rundek, Tatjana;DeCarli, Charles;Wright, Clinton B.;Sacco, Ralph L.;Di Tullio, Marco R.
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37.8
作者：
BENJAMIN, EJ;DAGOSTINO, RB;LEVY, D
通讯作者：
LEVY, D