高血压左心室肥厚患者的左心房收缩力:心房颤动的一个预测因素。LIFE研究

L. Gerholt, C. Bang, E. Gerdts, A. Larstorp, S. Kjeldsen, S. Julius, K. Wachtell, P. Okin, R. B. Devereux
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引用次数: 1

摘要

左心房收缩力(LASF)是衡量左心房功能的指标,目前尚不清楚是否可以作为新发心房颤动(NOAF)的预测指标。此外,阿替洛尔和氯沙坦治疗LASF的效果尚不清楚。共有758名基线时无心房颤动的患者参加了氯沙坦终点干预(LIFE)降低高血压超声心动图亚研究。LIFE研究的参与者被随机分组接受阿替洛尔或氯沙坦治疗。平均随访59个月。LASF采用平均二尖瓣口面积和二尖瓣峰值进行计算。速度通过多普勒超声心动图获得。基线时,25%的患者LASF≤10.3 kdyn。与其他四分位数相比,这四分位数的男性比例更高,心率、体重指数和年龄更低。在控制了这些变量后,与其他四分位数相比,第一个四分位数的患者的卒中量较低。29例(8.1/1000患者年随访)患者出现新发性房颤。在具有向后消除的多变量Cox回归分析中,LASF增加与NOAF的风险降低相关(危险比[HR]=0.90[95%置信区间0.85-0.96],p=0.001)。综合辨别能力改善0.054(p=0.004),净再分类改善19.2%(p=0.075)。随着时间的推移,阿替洛尔治疗组的LASF下降幅度大于氯沙坦治疗组(<0.001)与新发AF的风险较高有关。与阿替洛尔治疗相比,以氯沙坦为基础的治疗可更好地保存LASF。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Left Atrial Systolic Force in Hypertensive Patients with Left Ventricular Hypertrophy-: A Predictor of Incident Atrial Fibrillation. The LIFE Study
It remains unknown whether left atrial systolic force (LASF), a measure of left atrial function, can be used as a predictor of new-onset atrial fibrillation (NOAF). Furthermore, the effect of the treatment with atenolol and losartan on LASF is unclear. A total of 758 patients without atrial fibrillation at baseline were enrolled from the Losartan Intervention For Endpoint (LIFE) reduction in hypertension echocardiography sub-study. Participants of the LIFE study were randomized to either atenolol-or losartan-based treatment. The mean follow-up was 59 months. LASF was calculated using the average mitral orifice area and mitral peak. The velocity was obtained by Doppler echocardiography. At baseline, 25% of patients had a LASF ≤ 10.3 kdyn. Compared to other quartiles, this quartile had a higher proportion of men, lower heart rate, body mass index, and age. After controlling for these variables, patients in the first quartile had a lower stroke volume compared to other quartiles. New-onset AF occurred in 29 (8.1/1,000 patient-years of follow-up) patients. In multivariable Cox regression analyses with backward elimination, increasing LASF was associated with a lower risk of NOAF (hazard ratio [HR] = 0.90 [95% confidence interval 0.85-0.96], p = 0.001). Integrated discrimination improvement was 0.054 (p = 0.004) and there was a borderline significant net reclassification improvement of 19.2% (p = 0.075). Over time LASF decreased more in the atenolol-based than the losartan-based treatment group ( < 0.001). Low LASF was associated with a higher risk of new-onset AF. Losartan-based treatment was associated with better preservation of LASF compared to atenolol-based treatment.
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