高血压合并阵发性房颤患者心房收缩和电-机械时间的变化

目的：采用组织多普勒成像（TDI）技术研究高血压合并阵发性心房颤动（房颤）患者心房收缩和电-机械时间（A和P-A）及其离散度的变化。方法：原发性高血压患者103例，其中阵发房颤组（PAF组）23例，无阵发房颤组（NAF组）80例。选择健康人20例为对照组。采用TDI技术分别测量左、右房室瓣环处A和P—A值（LA和LP-A，RA和RP—A）。并计算其离散度。结果：PAF组LA、LP—A、RA、RP—A值及其离散度较另外两组明显延长（P〈0．01或P〈0．05）。NAF组LP—A、RP—A值较对照组延长（P〈0．05）。LP—A与左房大小（LAd）、左室质量指数（LVMI）、二尖瓣舒张晚期血流速度峰值（A）、二尖瓣环处心肌舒张早、晚期运动速度峰值（Ea、Aa）、Ea／Aa等指标存在不同程度的相关性。多元Logistic回归分析表明LAd、LVMI、Ea／Aa、LP—A是预测高血压患者发生阵发性房颤的重要指标。结论：心房电-机械时间在高血压患者延长。在合并阵发性房颤患者延长尤为明显且离散度变大，其有望成为一种预测高血压患者发生阵发性房颤的新指标。

Changes of Atrial Contraction Time and Electromechanical Time in Hypertensive Patients with Paroxysmal Atrial Fibrillation

Objective: To research the changes of atrial contraction time and electromechanical time and their dispersion in hypertensive patients with paroxysmal atrial fibrillation by Tissue Doppler Imaging (TDI). Methods: One hundred and three patients with essential hypertension were enrolled. Twenty three patients with history of paroxysmal atrial fibrillation (PAF group), eighty patients without history of paroxysmal atrial fibrillation (NAF group) and twenty healthy subjects as the control group were included. Atrial contraction time and electromechanical time were acquired by TDI on left and right atrioventricular annulus level (LA and LP-A, RA and RP-A). Their dispersion were calculated (T and TT). Results: Compared with NAF group and control group, LP-A, RP-A, LA, RA and their dispersion of the PAF group were longer(P < 0.01 or P < 0.05). LP-A and RP-A of the NAF group were longer than those of the control group(P < 0.05). LP-A had correlation with LAd, LVMI, A, Ea, Aa and Ea/Aa in different degree. Multivariate logistic regression analysis showed that LAd, LVMI, Ea/Aa and LP-A were important predictors for the onset of paroxysmal atrial fibrillation in hypertensive patients. Conclusion: Atrial electromechanical time is prolonged in hypertensive patients, especially in patients with paroxysmal atrial fibrillation, that also has larger dispersion. It should be a new predictor for the onset of paroxysmal atrial fibrillation in hypertensive patients.