The Clinical Study Of Cardiac Structure And Function Changes And Risk Factors In Hypertensive Patients Complicating With Atrial Fibrillation

Objective: To evaluate cardiac structure and function changes in hypertensive patients complicating with non-valvular atrial fibrillation(NVAF),and to explore the risk factors for atrial fibrillation in patients with hypertension.Method: In this retrospective study,a total of 286 hypertensive patients were collected,all of them met the inclusion and exclusion criteria of the study.Patients were divided into hypertensive group with atrial fibrillation(HTN+AF group,n=135cases)and hypertensive group without atrial fibrillation(HTN group,n=151 cases)according to the presence or absence of NVAF.In addition,120 people with age and gender matching were included as control group during the same period.IBM SPSS25.0 statistical software was used to analyze the general data of laboratory parameters,echocardiography parameters and holter data of the three groups.The risk factors of atrial fibrillation in hypertensive patients were evaluated by Logistic regression analysis.135 hypertensive patients combined with atrial fibrillation were divided into paroxysmal atrial fibrillation group(n=61 cases)and persistent atrial fibrillation group(n=74 cases),according to the type of AF,the baseline information and clinical data of the two groups were compared.Finally,the risk factors for the development of persistent atrial fibrillation in patients with paroxysmal atrial fibrillation were also evaluated.Results:(1)Compared with HTN group or control group,LAD,LVDs,LVDd,RVD,mitral regurgitation(MR),tricuspid regurgitation(TR),BNP,24-hours total heart beats,average heart rate,maximum heart rate were higher in HTN+AF group,but LVEF,LVFS were lower(P<0.05).The results showed significantly difference between HTN group and control group in IVST,LVPWT,LAD,MPAP,TR(P<0.05).(2)286 hypertensive patients were studied by multivariate logistic regression analysis,it showed smoke [OR=3.728,95%CI:(1.278,10.872),P=0.016],LAD [OR=1.194,95%CI:(1.065,1.338),P=0.002],RVD [OR=1.161,95%CI:(1.055,1.277),P=0.002],BNP [OR=9.146,95%CI:(3.169,26.398),P=0.000],24-hours total heart beats[OR=1.000,95%CI:(1.000,1.000),P=0.002],average heart rate [OR=1.109,95%CI:(1.002,1.226),P=0.045],maximum heart rate [OR=1.067,95%CI:(1.032,1.103),P=0.000] were independent risk factors for atrial fibrillation in hypertensive patients(P<0.05).(3)Compared with paroxysmal atrial fibrillation,LAD,LVDs,LVDd,mitral regurgitation,tricuspid regurgitation,MPAP,24-hours total heart beats,mean heart rate,and maximum heart rate were higher in patients with hypertension and persistent atrial fibrillation,while LVFS and LVEF were lower(P<0.05).By multivariate Logistic regression analysis,it showed LAD [OR=1.163,95%CI:(1.032,1.311),P=0.013],increased tricuspid regurgitation [OR=7.152,95%CI:(1.329,38.498),P=0.022] were independent risk factors for the progression of paroxysmal atrial fibrillation to persistent atrial fibrillation in hypertensive patients.Conclusion:(1)Left atrial diameter increased was an independent risk factor for the occurrence of non-valvular atrial fibrillation in patients with hypertension.(2)Increased right ventricular diameter and elevated BNP might be risk factors for non-valvular atrial fibrillation in hypertensive patients.(3)The increased heart rate might be involved in the formation of non-valvular atrial fibrillation in hypertensive patients.(4)The mitral and tricuspid regurgitation of patients with hypertension and atrial fibrillation was more severe.