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目的探讨射血分数正常性心力衰竭与左房重构的关系,为射血分数正常性心力衰竭的治疗提供科学依据。方法选择2009—2010年某三甲医院心脏科收治的基础疾病为高血压病、冠心病、糖尿病且射血分数正常的心力衰竭患者102例,其心功能分级为Ⅱ～Ⅳ级。应用多普勒超声心动图检测左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左房内径(LAD)、室间隔厚度(IVSD)、左室后壁厚度(LVPWD)、E/A值等多项指标,对比不同心功能分级患者的左房重构情况。结果心功能Ⅳ级组(15例)LAD大于心功能Ⅱ级组(47例),房颤发生率显著高于心功能Ⅲ级组(40例),差异均有统计学意义(P<0.05)。LAD≥40mm组房颤发生率高于左房内径为30～40mm组及左房内径为≤29mm组,差异有统计学意义(P<0.05)。结论射血分数正常性心力衰竭患者随着心衰程度的加重,左房内径扩大,房颤发生率增加;左房扩大可致房颤发生率增加;左房重构亦可引起心衰加剧。
Objective To explore the relationship between ejection fraction normal heart failure and left atrial remodeling and to provide a scientific basis for the treatment of heart failure with ejection fraction normal. Methods A total of 102 heart failure patients with hypertension, coronary heart disease, diabetes mellitus and normal ejection fraction were selected from the cardiology department of a top three hospital from 2009 to 2010. The heart function was graded as grade Ⅱ ~ Ⅳ. Left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD), left atrium diameter (LAD), interventricular septum thickness (IVSD), left ventricular posterior wall thickness (LVPWD) / A value and many other indicators, compared with different cardiac function grading patients with left atrial remodeling. Results The LAD of cardiac function grade Ⅳ group (15 cases) was significantly higher than that of cardiac function grade Ⅱ group (47 cases), the incidence of atrial fibrillation was significantly higher than that of grade Ⅲ group (40 cases), the difference was statistically significant (P0.05) . The incidence of atrial fibrillation in LAD≥40mm group was higher than that in left atrium with 30 ~ 40mm group and the left atrium diameter≤29mm group, the difference was statistically significant (P <0.05). Conclusions With the increase of heart failure, the left atrium diameter increases and the incidence of atrial fibrillation increases with the increase of left atrium. The left atrium enlargement can increase the incidence of atrial fibrillation. Left atrial remodeling can also cause worsening of heart failure.