| Background Essential hypertension (EH) is the common cause of left ventricular (LV) geometric remodeling which includes shape remodeling, volume remodeling and mass remodeling. The relation between the type of LV geometric remodeling and atrial fibrillation (AF) in patients with EH was unknown. Both AF and chronic heart failure (CHF) are common disorders. However, the prognosis and epidemiologic features of CHF patients with AF remain unclear.Objectives To explore the relation between the type of left ventricular geometric remodeling and AF in patient with EH. To observe the prognosis and epidemiologic features of CHF patients with AF.Methods 1. In accordance with hypertension guidline (JNC-7), consecutive inpatients with EH (n=211, from September, 2008 to August, 2009) were enrolled at the department of cardiology in PLA general hospital. The patients were devided into AF group and sinus rhythm (SR) group by baseline heart rhythm. The diagnosis of AF was conformed to ACC/AHA/ESC 2006 guidelines for the management of patients with AF executive summary. The patients underwent Doppler echocardiography examination which included LV sphericity index (LVSI), LV diastolic volume (LVEDV),LV mass (LVM) and left atrial sphericity index (LASI). The clinical and echocardiographic characteristics were compared by t test, Chi-square test and multiple Logistic regression analysis. Then AF group was divided into persistent group and paraxysmal group. The indices of echocardiography among 3 groups were compared by analysis of variance. 2. A total of 1161 patients with CHF were devided into AF or SR group. Criteria of Framingham were refered to diagnose CHF. The end-point events and epidemiologic features were compared between two groups. The end-point events were defined as death within one year and readmission to the hospital for heart failure.Results 1. Compared to SR group, AF group has lower systolic blood pressure and diastolic blood pressure (138.85±19.89mmHg VS 149.80±25.17mmHg; 80.57±13.04mmHg VS 85.97±15.81mmHg, P<0.01) and larger LVM, LVEDV, LVESV and LVSI (108.19±27.52g VS 99.69±21.61g, P<0.05; 199.20±57.00ml VS 181.92±50.62ml, P<0.05; 45.52±20.03ml VS 37.60±13.03ml, P < 0.01; 0.715±0.043 VS 0.688±0.040,P < 0.01), although LASI was significantly smaller (0.740±0.081 VS 0.779±0.08, P<0.01). Given covariates were adjusted in the Logistic regression model, the LVSI, LAD and LASI were independent factors associated with AF in patients with hypertension(OR:0.847, 95%CI:6.141±138.590, P<0.01; OR: 0.811, 95%CI: 0.738±0.891, P<0.01; OR: 65.836, 95%CI: 0.764±0.942, P<0.01). 2. There were 36% of patients with AF in CHF patients. The presenting history and clinical examination findings were similar in the two groups (P>0.05). Compared to SR patients, AF patients have higher mortality and readmission (Log Rank P<0.05) with 12 months follow-up. Given covariates were adjusted in the Cox regression model, AF was no longer related to increasing the risk of the mortality and readmission within one year (RR: 1.052, 95%CI: 0.938±1.165, P>0.05). A Cox model indicated that increased risk of main end-point events were asssociated with NYHA function classⅣ, age , LAD (P<0.001, P<0.05, P<0.05).Conclusions 1. Compared to SR group, AF group has significant variation in the type of left ventricular geometric remodeling in EH patients. The LVM and LV volume are much larger and there is a sphericity trend of LV in EH patients with AF. However, there is a deviation of sphericity of left atrial in EH patients with AF. The LVSI, LAD and LASI were the independent risk factors of EH patients with AF after adjustment for other covariates. With the development of AF, the degree of left ventricular geometric remodeling is increasing. 2. During 1 year follow-up, the mortality and readmission in patients with AF seems to be related to other factors, such as NYHA function classⅣ, age, LAD, instead of AF. |
PDF Full Text Request