심방 세동에 동반된 고혈압 환자에서 심장의 구조적 변화의 특징

Abstract

Backgrounds: Hypertension (HTN) is a major risk factor for the development of atrial fibrillation (AF), and the presence of HTN increases the morbidity and mortality of patients with AF. HTN induces many structural and functional abnormalities of the heart. However, which structural abnormalities are primarily associated with HTN in AF patients still remains to be determined. The aim of this study was to clarify the impact of HTN on the cardiac structural changes in patients with nonvalvular AF (NV-AF).

Methods: Two hundred ninety four patients (204males, age: 65.6±11.7years) with NV-AF with a preserved left ventricular (LV) systolic function were included from 6 medical centers. The clinical data was obtained and comprehensive echocardiographic examinations were performed. The patients with HTN (n=169; group 1) were compared with the patients without HTN (group 2).

Results: On univariate analysis, the LV mass index (LVMI [105.0±23.0g/m2 vs. 95.7±23.5g/m2]), the left atrial volume index (LAVI [46.4±20.2ml/m2 vs. 40.5±18.9ml/m2]), the deceleration time of the early mitral inflow velocity (DT [163±39ms vs. 175±44ms]), the mitral inflow velocity (E’ [7.7±2.1cm/s vs. 8.3±2.2cm/s]) and the mitral inflow velocity to the diastolic mitral annular velocity (E/E’ [12.1±4.4 vs. 11.0±4.5]) were significanlty different between groups 1 and 2, espectively, (P<0.05 for all). However, on the multivariate analysis, the LV mass index (LVMI), which reflects LV hypertrophy (LVH), was the only factor significantly correlated with HTN in the patients with NV-AF (P<0.05).

Conclusion:For patients with NV-AF with a preserved LV function, LVH was a cardiac structural abnormality that was independently associated with co-existing HTN. LVH may be related to the development and maintainence of AF and an increased cardiovascular risk in those patients.