Comparison of Pulmonary Venous and Left Atrial Remodeling in Patients With Atrial Fibrillation With Hypertrophic Cardiomyopathy Versus With Hypertensive Heart Disease
Comparison of Pulmonary Venous and Left Atrial Remodeling in Patients With Atrial Fibrillation With Hypertrophic Cardiomyopathy Versus With Hypertensive Heart Disease
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DOI：
10.1016/j.amjcard.2016.12.025
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发表时间：
2017-04-15
影响因子：
2.8
通讯作者：
Takeyasu, Noriyuki
中科院分区：
文献类型：
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作者：
Yoshida, Kentaro;Hasebe, Hideyuki;Takeyasu, Noriyuki
肥厚性心肌病（HC）左室舒张功能障碍增加心房颤动的易感性。虽然肥大左心室的表型特征是明确的，但左心房（LA）和肺静脉（PV）重构很少被研究。本研究旨在通过三维计算机断层扫描确定HC和高血压心脏病（HHD）之间LA和PV重塑的差异。纳入33例HC患者，25例HHD患者和29例无任何合并症的房颤导管消融患者。测量消融前血浆心房和脑钠肽水平、消融后肌钙蛋白T水平和左室压，三维测量左室和左室直径。对照组LA横径小于HHD或HC组（55 +/- 6 vs 63 +/- 9 vs 65 +/- 12 mm, p = 0.0003）。所有4个PV直径在HC组最大，HHD组次之（21.0 +/- 3.1 vs 23.8 +/- 2.8 vs 26.8 +/- 4.1 mm，左上PV p < 0.0001）。HHD组和HC组之间PV大小的差异通过指标化体表面积来增强（12.4 +/- 1.9 vs 13.1 +/- 1.4 vs 16.1 +/- 3.3 mm/m, p < 0.0001）。HC组PV/LA直径比高于其他组（0.38 +/- 0.06 vs 0.38 +/- 0.05 vs 0.42 +/- 0.07, p = 0.01）。HC组心房钠肽、脑钠肽、肌钙蛋白T水平和左室压均最高（p < 0.05）。综上所述，心房肥厚引起的LA僵硬可能是HC中生物标志物水平升高、LA压力升高和pv主导型重构的原因。(C) 2017爱思唯尔公司版权所有。
Left ventricular diastolic dysfunction in hypertrophic cardiomyopathy (HC) increases susceptibility to atrial fibrillation. Although phenotypical characteristics of the hypertrophied left ventricle are clear, left atrial (LA) and pulmonary venous (PV) remodeling has rarely been investigated. This study aimed to identify differences in LA and PV remodeling between HC and hypertensive heart disease (HHD) using 3-dimensional computed tomography. Included were 33 consecutive patients with HC, 25 with HHD, and 29 without any co-morbidities who were referred for catheter ablation of atrial fibrillation. Pre-ablation plasma atrial and brain natriuretic peptide levels, post-ablation troponin T level, and LA pressure were measured, and LA and PV diameters were determined 3 dimensionally. LA transverse diameter in the control group was smaller than that in the HHD or HC group (55 +/- 6 vs 63 +/- 9 vs 65 +/- 12 mm, p = 0.0003). PV diameter in all 4 PVs was greatest in the HC group and second greatest in the HHD group (21.0 +/- 3.1 vs 23.8 +/- 2.8 vs 26.8 +/- 4.1 mm, p < 0.0001 for left superior PV). Differences in PV size between the HHD and HC groups were enhanced by indexing to the body surface area (12.4 +/- 1.9 vs 13.1 +/- 1.4 vs 16.1 +/- 3.3 mm/m(2), p < 0.0001). The PV/LA diameter ratio was greater in the HC than in the other groups (0.38 +/- 0.06 vs 0.38 +/- 0.05 vs 0.42 +/- 0.07, p = 0.01). Atrial natriuretic peptide, brain natriuretic peptide, troponin T levels, and LA pressure were highest in the HC group (all p < 0.05). In conclusion, the stiff LA caused from atrial hypertrophy may account for higher levels of biomarkers, higher LA pressure, and PV-dominant remodeling in HC. (C) 2017 Elsevier Inc. All rights reserved.