孤立性房颤与高血压房颤患者左心重塑对比

目的:探讨高血压伴发的房颤和孤立性房颤患者左室质量等重塑状况异同及其意义。方法:房颤和(或)原发性高血压患者,排除对心脏有影响的其他疾病,分为原发性高血压无房颤组(EH组)、原发性高血压伴房颤组(EHAF组)和孤立性房颤组(LAF组)。进行超声心动图检测左房横径、左房前后径、左房长径、左房面积、左室室间隔厚度(IVST)、左室后壁厚度(PWT)和左室舒张末期内径(EDD),计算室间隔/左室后壁厚度比值和左室质量指数(LVMI)。结果: EH组入选446 例,EHAF组78例,LAF组38例。EHAF组IVST和PWT均明显大于EH组和LAF组(p<0.05和p<0.01),EH组IVST和PWT也大于LAF组(p<0.01和p<0.05)。EHAF组左房各内径和面积均明显大于LAF组和LH组(p<0.01),后两组间无明显差异。EHAF组LVMI明显大于LAF组和LH组(p<0.01和p<0.05),LAF组和LH组间无明显差异。结论:原发性高血压伴发房颤者左室肥厚程度明显重于不伴房颤者。左房扩大、左室肥厚性重塑与孤立性房颤的关系不如与高血压房颤密切,孤立性房颤发生的危险因子不同于高血压房颤。

Comparison of Left Heart Remodeling between Patients with Lone Atrial Fibrillation and Those with both Atrial Fibrillation and Essential Hypertension

Objective: To compare the remodeling of left ventricular mass index (LVMI) and other parameters. between patients with essential hypertension and atrial fibrillation and those with lone atrial fibrillation. Methods: Patients without diseases influencing heart structures were divided into three groups: essential hypertension (EH) group, essential hypertension with atrial fibrillation (EHAF) group and lone atrial fibrillation (LAF) group. The cross-sectional, anterior-posterior and longitudinal diameters and the area of the left atrium, the thickness of inter-ventricular septum (IVST), the thickness of left ventricular posterior wall (PWT) and the left ventricular end-diastolic diameter were measured with echocardiography. IVST/PWT ratio and LVMI were calculated. Results: 446, 78 and 38 patients were included in the EH group, EHAF group and LAF group respectively. IVST and PWT in EHAF group were thicker than those in EH and LAF groups (p<0.05 and 0.01). IVST and PWT in EH group were also thicker than those in LAF group(p< 0.01 and 0.05). All diameters and area of left atrum in EHAF group were markedly larger than those in LAF and LH groups(p< 0.01). LVMI in EHAF group was significantly bigger than that in the other two groups(p< 0.01 and 0.05). Conclusion:Hypertensive patients with atrial fibrillation have more severe left ventricular hypertrophy than those without atrial fibrillation. Lone atrial fibrillation has a weaker relation to left atrium enlargement and left ventricular hypertrophic remodeling than atrial fibrillation does in hypertensive patients.