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Objective:To investigate the predictive value of preoperative left atrial diameter in postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD) and its influencing factors.Methods:This study was a prospective observational study. A total of 113 patients with CABG surgery were enrolled in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2020 to December 2020. Preoperative coronary angiography, echocardiography and blood test were finished. The number of graft vessel was counted during the operation. The occurrence of POAF was confirmed by electrocardiogram or electrocardiograph monitoring after surgery. The preoperative baseline data, blood test, perioperative complications and other indicators of patients with or without POAF were compared.Results:According to the inclusion criteria and exclusion criteria, 90 patients undergoing CABG were enrolled in the study[71 males and 19 females, aged from 42 to 75, mean age (62±8)years old]. The incidence of POAF was 27.8%(25 cases). The left atrial diameter[40(36-43)mm vs. 35(33-37)mm, P=0.00]and troponin I[4.76(0.87-13.60)ng/ml vs. 1.48(0.56-4.52)ng/ml, P=0.04] in patients with POAF were significantly higher than that in patients without POAF. Compared to patients without POAF, POAF significantly increased the incidence of stroke[4(16%) vs. 0(0), P=0.01], ICU stay[67(24-96) days vs. 22(19-41) days, P=0.00] and hospital stay[21(19-24) days vs. 16(14-24) days, P=0.05]. Binary logistic regression showed that left atrial diameter was significantly correlated with the occurrence of POAF ( OR=1.9, 95% CI: 1.39-2.79, P<0.001). ROC curve analysis showed that 40 mm of left atrial diameter was a predictor of POAF( AUC=0.82, sensitivity 52%, specificity 100%, P<0.001). Linear regression analysis showed that left atrial diameter was significantly positively correlated with hypersensitive C-reactive protein ( Beta=0.24, 95% CI: 0.00-0.26, P=0.043). Conclusion:POAF significantly increased the incidence of stroke after CABG. Preoperative left atrial diameter is an independent predictor for POAF, which is closely related to the systemic inflammatory response.
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Objective To investigate the correlation of atrial arrhythmia with V1 lead P wave terminal potential (PTFV1) and left atrial diameter (LAD) in patients with obstructive sleep apnea syndrome (OSAS). Methods A total of 247 suspected OSAS patients, firstly hospitalized in Snoring Department of Gansu Provincial People's Hospital from Sep. 2017 to Apr. 2019, were included, and divided into four groups according to the apnea hypopnea index (AHI): AHI<5 as the control group (n=22), 5≤AHI<15 as the mild OSAS group (n=37), 15≤AHI<30 as the moderate OSAS group (n=46), and AHI≥30 as the severe OSAS group (n=142). Polysomnography (PSG) were collected, the incidence of atrial arrhythmia was observed by 24-h dynamic electrocardiogram, LAD was measured by echocardiography, and PTFV1 was measured by 12-lead electrocardiogram. The incidence of atrial arrhythmia in each group was compared, and the correlation between the occurrence of atrial arrhythmia and PTFV1 and LAD was analyzed. Results The incidences of atrial arrhythmia in the mild, moderate and severe group (16.2%, 23.9% and 17.6%, respectively) were significantly higher than that in the control group (0, P<0.05), but no significant difference existed among the mild, moderate and severe group. PTFV1 was positively associated with the incidence of atrial arrhythmia in patients with OSAS (r=0.394, P<0.01). LAD was positively correlated with the incidence of atrial arrhythmia in patients with OSAS (r=0.235, P<0.01). Conclusion The occurrence of atrial arrhythmia in OSAS patients is associated with the abnormal increase of PTFV1 and LAD, which indicates that the occurrence of atrial arrhythmia in OSAS patients is related to the electrical and structural remodeling of the left atrium.
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Objective To analyze and compare the classification of left atrial size by different echocardiographic measurements based on the latest large sample of normal Chinese adults'echocardiographic data . Methods The echocardiography data of 1067 unselected adult outpatients were retrospectively analyzed . The outpatients were divided into normal or enlarged groups according to the left atrialantero-posteriordiameter(LAD)andleftatrialvolume(LAV),respectively.Results ①LADand LAV enlargement were found in 299 (28 .0％ ) patients and 449 (42 .1％ ) patients of the total population , respectively . ②There was a good positive linear correlation between LAD and LAV ( r = 0 .642 , P =0 .000) ,but the agreement for the classification of left atrial size by LAD and LAV was not ideal ( Kappa =0 .392 , P = 0 .000) . The majority of the patients ( 74 .6％ ) with abnormal LAD had abnormal LAV . Conversely ,among the patients with abnormal LAV ( 50 .3％ ) had normal LAD . ③ The sensitivity and specificity of judging left atrial enlargement were 76 .8％ and 66 .8％ for LAD>3 .7 cm in male ,and 74 .9％and 70 .6％ for LAD>3 .4 cm in female ,respectively . The sensitivity and specificity of judging severely left atrial enlargement were 75 .5％ and 78 .7％ for LAD>4 .0 cm in male ,and 84 .2％ and 75 .8％ for LAD>3 .7 cm in female ,respectively . Conclusions The agreement of the classification of left atrial size by LAD and LAV is limited . LAD-based assessment may result in an underestimation of left atrial size . When LAD is larger than 4 .0 cm for male or 3 .7 cm for female ,the accuracy of LAD in the diagnosis of left atrial enlargement is better .
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Objective To analyze the relationship and clinical significance of serum glutamyl transpeptidase (GGT) level with left atrial diameter.Methods All the newly diagnosed 200 essential hypertension patients with complete data were selected.They were divided into normal left atrial group and enlarged left atrial group based on the size of left atrial diameter.Fasting blood glucose,serum lipid,routine laboratory tests,hepatic and renal function and blood pressure were measured by routine methods,and compared between the two groups.Results The GGT level in the enlarged left atrial group was lower than that in the normal left atrial group among essential hypertension patients [(21.56 ± 11.95) U/L vs.(37.28 ± 12.64) U/L] (P =0.001).Spearman correlation showed that GGT level was negatively associated with left atrial diameter(r =-0.413,P =0.002).Multiple linear regression analysis showed that the serum GGT was also negatively correlated with left atrial diameter(β =-0.394,95 ％ CI:-0.131,-0.692;P =0.005).Conclusion Our study demonstrated that the level of GGT was negatively correlated with left atrial diameter among essential hypertension patients,and monitoring the changes of serum liver enzyme may have significant effect on the early detection of enlarged left atrial diameter.
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Objective To analyze the relationship and clinical meaning of serumglutamyl transpeptidase (GGT) level with left atrial diameter.Methods All the 320 essential hypertension patients from Ganzhou People′s Hospital were divided into normal left atrial group and enlarged left atrial group based on the size of left atrial diameter.Fasting blood glucose,serum lipid,routine laboratory tests,hepatic and renal function and blood pressure were measured by routine methods,and used for analyzing between groups.Results Among essential hypertension patients,the GGT level in enlarged left atrial group [(24.78±10.93)U/L] was lower than normal left atrial group[(35.23±12.46)U/L] (P=0.004).Multiple linear regression analysis showed that the serum GGT was negatively correlated with left atrial diameter (P=0.032),and logistic regression analysis showed that GGT was a protective factor for enlarged left atrial (OR=0.424,P=0.026).Conclusion Our study demonstrated the level of GGT was negatively with left atrial diameter among essential hypertension patients,and monitoring the changes of serum liver enzyme may has significant effect on the early detection of enlarged left atrial diameter.
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Objective To assess the therapeutic effect and safety of radiofrequency catheter ablation of atrial fibrillation.Methods We analyzed the clinical data of 47 patients with atrial fibrillation who underwent radiofrequency catheter ablation between March 2013 and January 2008,in the First Affiliated Hospital of Xi'an Jiaotong University.In the average 32 months’follow-up,Holter monitering and echocardiography were reviewed for the left atrial diameter.Results The immediate success rate of catheter ablation for atrial fibrillation was 82.6%.The long-term success rate was 65%,the rate of paroxysmal atrial fibrillation was 69.7%,and the rate of longstanding persistent atrial fibrillation was 42.9%.After ablation,the left atrial diameter were markedly reduced compared with that before treatment [(36.3 ± 4.3 )mm vs .(38.1 ± 5.9 )mm)(P < 0.001 ).The patients with recurrent atrial fibrillation were older than those without recurrence,their left atrial diameter was bigger,and the prevalence rate of hypertension was higher (P <0.05).The average atrial fibrillation load was 14.9% after ablation compared with 46.1% before (P <0.05).Conclusion Radiofrequency catheter ablation is an effective and safe treatment of atrial fibrillation,especially for paroxysmal atrial fibrillation.The left atrial diameter was significantly decreased after radiofrequency catheter ablation compared with that before the ablation.
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Objective: To explore the risk factors in patients with chronic heart failure (CHF) combining atrial ifbrillation (AF) and to identify the predictive factors for AF recurrence after cardio version. Methods: A total of 246 CHF patients treated in our hospital were divided into 2 groups: CHF+AF (AF) group,n=71 and CHF without AF (Non-AF) group,n=175. The baseline information was recorded. The risk factors for AF occurrence were screened by Logistic regression analysis. There were 66 AF patients with successful cardio verse and they were followed-up for 18 months, the predictors for AF recurrence were studied by Cox regression analysis. Results: The baseline information showed that age, CHF duration, left atria diameter (LAD), the levels of BNP, uric acid and serum creatinine in AF group were all higher than those in Non-AF group, allP<0.05. Logistic regression analysis presented that age (RR=1.89, 95% CI 1.08-3.31,P<0.05), CHF duration (RR=1.35, 95% CI 1.05-1.74,P<0.05), BNP level (RR=1.82, 95% CI 1.30-2.53,P<0.01), LAD (RR=1.51, 95% CI 1.09-2.08,P<0.05) were the risk factors for AF occurrence. Cox regression analysis indicated that BNP level (RR=1.30, 95% CI 1.09-1.54,P<0.01) and LAD (RR=1.74, 95% CI 1.30-2.34, P<0.01) were the predictors for AF recurrence. Conclusion: The elder age, longer CHF duration, increased BNP level and LAD were the risk factors for AF occurrence in CHF patients. The increased BNP level and LAD were the objective predictors for AF recurrence after cardio version.
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OBJECTIVE:To explore the effect of olmesartan on NT-proBNP and high-sensitive C- reactive protein(hs-CRP) and left atrial diameter (LAD) in elderly hypertensive patients with paroxysmal atrial fibrillation (PAF). METHODS:188 cases of elderly hypertensive patients with PAF from May 2011 to May 2013 were divided into control group(n=94)and observation group (n=94),both groups received the treatment of amiodarone,observation group were additionally given olmesartan on the basis of conventional treatment,the treatment cycle was 12 months in two groups. NT-proBNP,hs-CRP,LAD changes and atri-al fibrillation(AF)recurrence were compared between 2 groups before(T0)and after 1 month(T1),3 months(T2),6 months (T3)and 12 months(T4)treatment;related factors for recurrence of atrial fibrillation were analyzed. RESULTS:NT-proBNP and hs-CRP in observation group were lower than control group at T3-T4,with significant difference(P<0.05);LAD improvement in observation group was better than control group,with significant difference (P<0.05). After treatment,the decent range of NT-proBNP and hs-CRP in observation group were higher than that control group,with significant difference(P<0.05);AF re-currence in observation group were lower than control group at T3-T4,with significant difference(P<0.05);Multiple stepwise re-gression analysis showed that NT-proBNP and hs-CRP were positively related with LAD,with significant difference (P<0.05);multi-factor logistic regression analysis showed that the NT-proBNP level,hs-CRP,LAD were positively correlated with AF re-currence,NT-proBNP drop and hs-CRP drop were negatively correlated with AF recurrence. CONCLUSIONS:Serum NT-proB-NP and hs-CRP levels are closely related to LAD and AF recurrence in elderly hypertensive patients with PAF,and olmesartan can decrease the plasma NT- proBNP CRP levels,reduce inflammation response and improve left atrial remodeling so as to re-duce the AF recurrence.
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Objective Atrial structure remodeling is the important pathologic basis of generate and development in chronic atrial fibrillation(AF) of valvular heart disease.To analyze the changed feature of AF in rheumatic mitral valve stenosis (MS) and mitral valve prolapse(MVP) after mitral valve surgery,along with fundamental change of hemodynamics in left atrial.Methods Firstly,divided into sinus rhythm (SR) group and AF group according to cardiac rhythm postoperative 6 months,and then divided into MS and MVP two subgroups with age matched,namely rheumatic sinus rhythm group (RS group),MVP sinus rhythm group(PS group),rheumatic AF group(RAF group) and MVP AF group(PAF group),30 patients in each group.Independent sample t test andx2 test were used in comparison among groups,and matched t test in preoperative and postoperative comparison of each group.Results There are 15 (50％) AF patients before surgery and 10 (33.3％) AF patients postoperative 1 month in RS group.But cardiac rhythm of MVP patients has no significant change.Left atrial diameter(LAD) in AF group was larger than in SR group significantly preoperative and postoperative 1 month and 6 months(P ＜ 0.05),and LAD have no significant difference between RAF and PAF group,P ＞ 0.05 ; LAD in RS group preoperative and postoperative 1 month was larger than in PS group(P =0.008 and 0.018,respectively),but there is no significant difference between RS and PS groups postoperative 6 months(P =0.558).Systolic peak velocity(Smm) at valve ring with PWTDI were(6.0 ± 1.4) cm/s,(6.7 ± 1.8) cm/s and (6.2 ± 1.6) cm/s preoperative and postoperative 1 month and 6 months,lower than normal range obviously; Smm before surgery in PAF group was(9.3 ± 3.7)cm/s,but reduced obviously after surgery 1 month and 6 months and near the level of rheumatic patients.Conclusion Generate and development mechanism of AF in MS and MVP patients exist some extent difference,the rhythm of partial MS patients with chronic AF will turn to and maintain sinus rhythm along with LAD decreased,there is no this characteristic in MVP patients.
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This study was aimed to observe the influence of Kang-Xian Y i-Xin (KXYX) formula on the heart size and cardiac function of patients with dilated cardiomyopathy (DCM). A total of 85 cases were randomly divided into the treatment group (43 cases) and the control group (42 cases, with 1 death case). Both groups were treated with routine western medicine. And the KXYX formula was combined in the treatment group once a day. Six months later, changes of the left ventricular end diastolic diameter (LVEDD), left atrial diameter (LAd), ejection fraction (EF) and fractional shortening (FS) were observed by ultrasonography. The results showed that both groups can reduce the LVEDD and Lad. And the effect was obvious in the treatment group (P< 0.05). There was significant difference in the LVEDD of both groups after treatment (P< 0.05). The EF and FS were raised obviously in both groups. There was significant difference before and after treatment in the treatment group (P < 0.01). There was statistical differ-ence between groups after treatment (P< 0.05). It was concluded that the KXYX formula can decrease the LVEDD, Lad, enhance EF and FS, in order to promote the cardiac function of patients with DCM.
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Objective To analyze the relationship between atrial fibrillation (AF) and plasma mononuclear cells or cardiac func-tion .Methods From April 2010 to Jun 2013 ,298 patients with AF from department of cardiology in our hospital were selected as study group ,300 patients without AF were selected as control group in the same period .Both group and the subgroup were analy-sised by t test .Results Plasma monocyte NT-proBNP ,left atrial diameter in AF group were significantly higher than the control group(P<0 .05) ,LVEF was lower than the control group ,the statistical differences between the two groups (P<0 .05) .Compare HF combine AF with HF only ,the NT-proBNP and left atrial diameter were significantly higher in former and the LVEF is lower than the latter ,both with the difference statistical significantly (P< 0 .05) .Merge heart failure combined with atrial fibrillation (HF+AF) and heart failure combined sinus rhythm (HF+ SR) group ,the former in the NT-proBNP and left atrial diameterwere significantly higher than the latter ,LVEF lower than the latter ,the difference was statistically difference (P<0 .05) .Conclusion In the development of AF ,the monocytes may be involved in the occurrence and development of AF .
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Objective: To explore the relationship between ambulatory arterial stiffness indexes (AASI), AASI-blood pressure variability (AASI-BPVR) and left ventricular mass index (LVMI) left atrium diameter (LAD) in patients with hypertension. Methods: A total of 286 hypertensive patients were enrolled in this study. The AASI, AASI-BPVR were calculated from 24-hour ambulatory blood pressure monitoring. Left ventricular internal dimension in diastole (LVIDd), interventricular septal thickness in diastole (IVSd), posterior wall thickness in diastole (PWd), LAD were detected by echocardiography and LVMI, relative wall thickness (RWT) were calculated. The fasting blood glucose, blood lipids were examined. According to 24 h AASI, the patients were divided into 2 groups, Group A, the patients with AASI > 0.51, n=133 and Group B, the patients with AASI ≤ 0.51,n=153. Pearson and multi regression analysis were conducted to analyze the relevant correlations. Results: Group A had increased LVMI than that in Group B,P Conclusion: AASI and AASI-BPVR were not the independent factors for left ventricular hypertrophy and left atrial enlargement, therefore, they were not the predictors for cardiac damage in patients with hypertension at present time.
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BACKGROUND: Atrial fibrillation is the most common significant cardiac arrhythmia in clinical practice, but its risk factors remain to be clarified. We have hypothesized that left ventricular posterior wall thickness is an independent risk factor for paroxysmal atrial fibrillation (PAF). METHODS: A total of 166 consecutive patients with paroxysmal atrial fibrillation were included in this study. Another 166 healthy check-up people, strictly age and sex-matched, were enrolled as controls in the same period. Univariable analysis and multivariable conditional logistic stepwise regression analysis were conducted. Receiver operating characteristic (ROC) curve analysis was performed on those significant indices obtained from the multivariable logistic regression analysis. RESULTS: The multivariable stepwise analysis identified left ventricular posterior wall thickness, left atrial diameter, tricuspid insufficiency and residence (countryside) as independent predictors for paroxysmal atrial fibrillation. Receiver operating characteristic curve analysis demonstrated the cut-off values of those risk factors aforementioned. CONCLUSIONS: In this strictly age and sex-matched population-based sample, left ventricular posterior wall thickness, left atrial diameter, tricuspid insufficiency and residence were predictive risks for paroxysmal atrial fibrillation. This study offers novel information therapeutically beyond that provided by traditional clinical atrial fibrillation risk factors.
ANTECEDENTES: La fibrilación atrial o auricular, es la arritmia cardíaca significativa más común en la práctica clínica, pero sigue siendo aún necesario poner en claro sus factores de riesgo. El presente trabajo asume la hipótesis de que el grosor de la pared posterior ventricular izquierda constituye un factor de riesgo independiente para la fibrilación atrial paroxística (FAP). MÉTODOS: El estudio abarca un total de 166 pacientes consecutivos con fibrilación atrial paroxística. Otras 166 personas saludables según el reconocimiento médico, pareadas estrictamente por edad y sexo, fueron registradas como controles en el mismo periodo. Se llevó a cabo un análisis de regresión logística condicional multivariante paso a paso y un análisis univariante. El análisis de la curva característica de la operación del receptor (ROC) se realizó sobre los índices significativos obtenidos a partir del análisis de regresión logística multivariante. RESULTADOS: El análisis multivariante paso a paso identificó el grosor de la pared posterior ventricular izquierda, el diámetro atrial izquierdo, la insuficiencia tricúspide y la residencia (el campo) como predictores independientes de la fibrilación atrial paroxística. El análisis de la curva característica de la operación del receptor demostró los valores límites de los factores de riesgo mencionados arriba. CONCLUSIONES: En esta muestra basada estrictamente en una población pareada por edad y género, el grosor de la pared posterior ventricular izquierda, el diámetro atrial izquierdo, la insuficiencia tricús-pide y la residencia, fueron riesgos predictivos de la fibrilación atrial paroxística. Este estudio ofrece información novedosa, terapéuticamente más allá de la proporcionada por los factores de riesgo clínicos tradicionales de la fibrilación atrial.
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Aged , Female , Humans , Male , Middle Aged , Atrial Fibrillation/pathology , Heart Ventricles/pathology , Tricuspid Valve/pathology , Chi-Square Distribution , China , Logistic Models , ROC Curve , Risk FactorsABSTRACT
Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.
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LAD(OR=1.209). Conclusion Left atrial diameter was independent risk factor for ischemic stroke in hypertensive patients.
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Objective To observe the earlier changes of left heart structure and function in patients with Grade 1 hypertension.Methods 65 patients with Grade 1 hypertension were measured on the left atrial diameter(LAD),left ventricular diameter,thickness of ventricular,mass index and evaluate the left ventricular systolic and diastolic function by UCG.Results Compaired to 50 normal controls,the LAD and left ventricular diastolic function of the patients(38.06?3.68 mm,0.72?0.11) was significantly different with those of 50 normal controls(29.86?3.08 mm,1.18?0.08)(P