老年阵发性心房颤动患者心房内及心房间的不同步性研究

摘要

Objective To evaluate intra- and interatrial asynchrony and its determinants in aged patients with paroxysmal atrial fibrillation (PAF) by using tissue Doppler imaging. Methods Ninty-one patients without PAF (control group, including 40 elder patients and 51 non-elder patients) and 52 aged patients with PAF were included. As to assessment of intra- and interatrial synchronicity, the atrioventricular plane were selected on the right atrial (RA) free wall, interatrial septum (IAS), and left atrial (LA) free wall. The time differences from the onset of the P wave to the onset of the A wave at the left atrium (P-LA), the IAS (P-IAS), and the right atrium (P-RA) were measured. Intra-atrial asynchrony was defined as the differences between P-IAS and P-RA (RA asynchrony) and between P-LA and P-IAS (LA asynchrony). Interatrial asynchrony was defined as the difference between P-LA and P-RA. Stepwise regression was made to determine the influencing factors for atrial asynchrony in aged patients with PAF. Results Compared with the control group, aged patients with PAF had significant LA and interatrial asynchrony (P＜0.01). Multivariate stepwise regression demonstrated that systolic blood pressure (x2), age (x1) and left ventricular mass index (LVMI x5) entered the regression equation in aged patients with PAF (Y=-57.241+0.481 x1+0.223 x2+0.294 x5). Conclusions Aged patients with PAF have LA and interatrial asynchrony. LVH, aged and SBP are important factors leading to these asynchronies in the aged patients with PAF.%目的 研究老年阵发性心房颤动(房颤)患者心房内和心房间的不同步运动,并进一步探讨其不同步性的影响因素.方法 采用组织多普勒成像(TDI)技术,在心尖四腔观测右心房游离壁、房间隔和左心房游离壁各取样点处心电图P波开始到TDI(PW-TDI)上A波起始点的时限:右心房(P-RA)、房间隔(P-IAS)、左心房(P-LA).比较 51例非老年对照组、40例老年对照组与52例老年阵发性房颤组心房内和心房间的不同步性.应用多因素逐步回归方法探讨老年阵发性房颤患者心房不同步的主要影响因素.结果 老年阵发性房颤患者的左房内、心房间不同步性较老年对照组显著增大(P＜0.01),右心房内不同步性差异无统计学意义.老年阵发性房颤组多因素逐步回归分析结果显示,左房内不同步性与收缩压(x2)、年龄(x1)、左室质量指数(LVMI,x5)具有相关性,回归方程为Y=-57.241+0.481 x1+ 0.223 x2+0.294 x5.结论 老年阵发性房颤患者存在显著的左心房内、心房间不同步性;收缩压、年龄、LVMI是老年阵发性房颤患者左心房内、心房间不同步性的主要影响因素.