Impact of changes in left heart geometry on predicting new-onset atrial fibrillation in patients with hypertension.

IF 3.3 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Hypertension Pub Date : 2024-09-12 DOI:10.1097/hjh.0000000000003875

Hyue Mee Kim,In-Chang Hwang,Jiesuck Park,Hye Jung Choi,Hong-Mi Choi,Yeonyee E Yoon,Goo-Yeong Cho

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引用次数: 0

Abstract

BACKGROUND Hypertension-induced left ventricular hypertrophy (LVH) increases end-diastolic LV pressure and contributes to left atrial enlargement (LAE), which are associated with development of atrial fibrillation. However, the impact of LVH and LAE and their regression following antihypertensive therapy on atrial fibrillation incidence remains unclear. METHODS This retrospective analysis included consecutive patients with sinus rhythm who underwent echocardiography at hypertension diagnosis and after 6-18 months between 2006 and 2021 at tertiary care centres in Korea. LVH was defined as LV mass index greater than 115 g/m2 (men) and greater than 95 g/m2 (women), and LAE was defined as LA volume index greater than 42 ml/m2. The occurrence of new-onset atrial fibrillation (NOAF) was assessed in relation to changes in LVH and LAE status. RESULTS Among the 1464 patients included, 163 (11.1%) developed NOAF during a median 63.8 [interquartile range (IQR) 35.9-128.5] months of surveillance period. New-onset LVH [adjusted hazard ratio (aHR) 1.88, 95% confidence interval (CI) 1.20-2.94, P = 0.006] and LAE (aHR 1.89, 95% CI 1.05-3.40, P = 0.034) were significant predictors of NOAF. Conversely, regression of LVH (aHR 0.51, 95% CI 0.28-0.91, P = 0.022) or LAE (aHR 0.30, 95% CI 0.15-0.63, P = 0.001) was associated with a reduced risk for developing NOAF. Patients with both LVH and LAE at follow-up echocardiography had a higher risk for NOAF (aHR 4.30, 95% CI 2.81-6.56, P < 0.001) than those with either LVH or LAE or those with neither. CONCLUSION The changes in left heart geometry can serve as a predictive marker for NOAF in patients with hypertension.

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左心几何学变化对预测高血压患者新发心房颤动的影响。

背景高血压引起的左心室肥厚（LVH）会增加左心室舒张末压并导致左心房扩大（LAE），这与心房颤动的发生有关。方法：这项回顾性分析纳入了 2006 年至 2021 年间在韩国三级医疗中心接受超声心动图检查的连续窦性心律患者，这些患者在高血压诊断时和 6-18 个月后接受了超声心动图检查。LVH 的定义是 LV 质量指数大于 115 g/m2（男性）和大于 95 g/m2（女性），LAE 的定义是 LA 容积指数大于 42 ml/m2。结果在纳入的 1464 名患者中，有 163 人（11.1%）在中位 63.8 个月（四分位间距（IQR）35.9-128.5）的监测期间发生了新发心房颤动（NOAF）。新发 LVH [调整后危险比 (aHR) 1.88，95% 置信区间 (CI) 1.20-2.94，P = 0.006] 和 LAE（aHR 1.89，95% CI 1.05-3.40，P = 0.034）是 NOAF 的重要预测因素。相反，LVH 回归（aHR 0.51，95% CI 0.28-0.91，P = 0.022）或 LAE 回归（aHR 0.30，95% CI 0.15-0.63，P = 0.001）与罹患 NOAF 的风险降低相关。在随访超声心动图检查时同时存在 LVH 和 LAE 的患者比同时存在 LVH 或 LAE 或两者均不存在的患者罹患 NOAF 的风险更高（aHR 4.30，95% CI 2.81-6.56，P＜0.001）。

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来源期刊

Journal of Hypertension 医学-外周血管病

CiteScore

7.90

自引率

6.10%

发文量

1389

审稿时长

3 months

期刊介绍： The Journal of Hypertension publishes papers reporting original clinical and experimental research which are of a high standard and which contribute to the advancement of knowledge in the field of hypertension. The Journal publishes full papers, reviews or editorials (normally by invitation), and correspondence.