Relationship Among Serum Soluble ST2 Level,Left Atrium Remolding And Atrial Arrhythmia In Patients With Primary Hypertension

Objective: To investigate the relationship among serum sST2 level,left atrium remolding and atrial arrhythmia in patients with primary hypertension.Methods:1 71 patients with primary hypertension were enrolled in the cardiovascular department of Hebei People’s Hospital from January 2015 to December 2016.We recorded the patient’s gender,age,course of disease,body mass index(BMI)and other indicators.Serum soluble ST2(sST2),interleukin33(IL-33),atrial natriuretic peptide(ANP)and type I collagen were detected by ELISA.2 After admission,twelve lead electrocardiogram was used to record the time limit of P wave,P wave amplitude,QRS duration,QT and QTc.24 hour ambulatory electrocardiogram(ECG)was performed to record the atrial arrhythmia,and the atrial arrhythmias were classified according to the Kleigar classification criteria: mild atrial arrhythmia group was K0-K2 and complex atrial arrhythmia group was K3-K6.3 24 hour ambulatory blood pressure monitoring was performed to record the mean systolic blood pressure and mean diastolic pressure of all day,daytime and night.4 Echocardiography measured patients’ left atrium diameter(LAD),right atrium diameter(RAD),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),interventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPWT)and left ventricular ejection fraction(LVEF).Left ventricular mass index(LVMI)was calculated according to Devercux formula.According to the enlargement of left atrium in patients with hypertension,the patients were divided into two groups:the left atrium enlargement group and the left atrium normal group.5 The indexes of left atrium normal group and left atrium enlargement group were statistically analyzed.Statistically significant indexes were screened out.Taking LAD as dependent variable and taking statistically significant indexes as independent variable entered multiple linear stepwise regression analysis.6 The incidence of atrial arrhythmias in the left atrium enlargement group and the left atrium normal group were compared,and the possible causes of atrial arrhythmias were analyzed.Results:1 In the patients with primary hypertension,the duration of the left atrial enlargement group was longer than that of the left atrium normal group[7.76(2.00,10.00)vs.1.00(0.53,4.25),P<0.001].There were no significant differences in gender,age,BMI and other indicators(P>0.05).2 In the patients with primary hypertension,the IVST of the left atrium enlargement group was thicker than that of the left atrium normal group[(10.02 ± 1.54)vs.(9.27 ± 0.64),P<0.05].There was no significant difference in RAD,LVEDD,LVESD,LVEF,LVPWT and LVMI(P>0.05).3 In the patients with primary hypertension,the average daytime SBP of the left atrium enlargement group was higher than that of the left atrium normal group[(138.17 ± 16.41)vs.(129.90 ± 14.44),P<0.05].The average night SBP of the left atrium enlargement group was higher than that of the left atrium normal group[(132.49±20.35)vs.(120.93±13.07),P<0.05].There was no significant difference in other indexes of ABPM(P>0.05).4 In the patients with primary hypertension,The serum sST2 level in the left atrium enlargement group was higher than that in the left atrium normal group[(3.12±0.75)vs.(1.48±0.29),P<0.001].The serum IL-33 level in the left atrium enlargement group was higher than that in the left atrium normal group[(131.46±22.39)vs.(104.81±25.62),P<0.001].The serum ANP level in the left atrium enlargement group was higher than that in the left atrium normal group[(57.89±3.25)vs.(46.70±2.94),P<0.001].The serum type Icollagen level in the left atrium enlargement group was higher than that in the left atrium normal group[(30.91±3.12)vs.(24.89±4.03),P<0.001].There were no significant differences in other serum markers(P>0.05).5 LAD was taken as the dependent variable Y and course of disease,IVST,ABPM mean SBP of daytime,ABPM mean SBP of night,sST2,IL-33,ANP,type I collagen were independent variables X1,X2,X3,X4,X5,X6,X7,X8.Dependent variable and independent variable entered multiple linear stepwise regression analysis.Excluded the independent variables: X1、X3、X6、X8.X2,X4,X5,X7 and LAD exsisted linear regression relationship(F=22.753,P<0.001).The difference of X2、 X4 、 X5 、 X7 was statistically significant(b2=0.751,b4=0.036,b5=0.918,b7=0.222,P<0.05).Standardized regression coefficients were 0.263,0.180,0.252,and 0.384.According to the standardized regression coefficient,ANP had the greatest impact on left atrium remolding.,6 Primary hypertension patients’ incidence of complex atrium arrhythmia in left atrium normal group was lower than that of the left atrium enlargement group(26.7% vs.51.2%,P<0.05).Conclusions:1 sST2,ANP,IVST and ABPM mean SBP of night have the linear regression relationship with left atrium remolding in primary hypertension patients.ANP had the greatest impact on left atrium remolding,followed by IVST,sST2,ABPM mean of SBP.The above mentioned indexes may have predictive value for left atrial remodeling.2 In patients with primary hypertension,patients with enlarged left atrium were more likely to have complex atrial arrhythmias than those with normal left atrium size.Due to the small number of samples in this experiment,the conclusions need to be further studied.