高血压及冠心病患者左心房扩大与心功能的相关性

背景临床观察发现高血压及冠心病患者普遍存在左心房扩大,但左房扩大的发生机制及临床意义尚未完全明了.目的探讨高血压及冠心病患者左心房内径的变化的临床意义及其与心功能的相关性.设计以诊断为依据的病例对照研究.地点、对象和方法选择在成都军区昆明总医院就诊的360例高血压患者、286例冠心病患者及255例健康人为研究对象.应用彩色多普勒超声心动图仪、三导心电图仪及24h动态心电图仪,测定左房内径、左室舒张末内径(1eft ventricular diastolic diameter,LVDd)、左室后壁厚度(1eftventricular posterior wallthickness,LVPWT)、室间隔厚度(septalthink-ness,WST)、每搏输出量(stroke volume,SV)、每分输出量、射血分数值、E/A比值.以观察左房扩大及左室肥厚与心功能的相关性.主要观察指标各组患者左房内径的变化,左房内径与左心室肥大及心功能的关系.结果高血压组及冠心病组左房内径分别为(30.13±5.54),(31.35±5.84)mm较正常对照组(26.82±6.11)mm]显著增加.高血压组及冠心病组伴LAD扩大者射血分数(49.12±12.11)%]及E/A(0.86±0.2)显著降低.结论高血压组及冠心病患者左房内径较正常者增加,1/3以上高血压组及冠心病组患者伴有左房扩大.左房内径扩大与左心室肥大及心功能减退有关;左房内径扩大可能是高血压组及冠心病病情进展及心功能减退的标志.

Correlation between cardiac function and the left atrium enlargement in the patients with hypertesion and coronary heart disease

BACKGROUND:As revealed by clinical observation, the left atrium enlargement commonly exits in most hypertensive and coronary heart disease patients.However, the mechanism of the left atrium enlargement is unknown.OBJECTIVE:To investigate the alteration and the clinical significance of left atrium(LA) enlargement in hypertension and coronary heart disease patients as well as its correlation with cardiac function.DESIGN:A case-controlled study on the basis of diagnosis.SETTING, PARTICIPANTS and INTERVENTIONS:A total of 360 hypertensive patients, 286 coronary heart disease patients were selected from the patients of Kunming General Hospital.255 healthy subjects were also included in our study.Color Doppler Ultrasonography imager, three-lead ECG and 24-hour dynamic ECG were used to measure the internal diameter of left atrium(LAD), left ventricular diastolic diameter(LVDd), left ventricular posterior wall thickness(LVPWT), septal thickness(IVST), stroke volume(SV),output volume of every minute, ejection fraction(EF), and E/A ratio for the observation of the correlation between the left atrium enlargement, left ventricle thickening, and cardiac function.MAIN OUTCOME MEASURES:The changes of LAD, the relationship between LAD, the LV hypertrophy and the cardiac function.RESULTS:LAD significantly increased in hypertension and coronary heart disease patients, which were(30.13 ±5.54) and(31.35 ±5.84) mm respectively, compared with that(26.82 ± 6.11 ) mm of the control group.The EF and E/A of patients with LAD enlargement in both hypertension group and coronary disease group were(49.12 ± 12.11)% ] and(0.86 ±0.2)respectively, which significantly decreased.CONCLUSION:LAD in the patients with hypertension and coronary disease increases compared with normal subjects.More than 1/3 of the patients are companied with LA enlargement.LA enlargement and LV hypertrophy relate with the subsidence of cardiac function.LA enlargement might be a marker of the development of hypertension and coronary heart disease, and a marker of the subsidence of cardiac function as well.