Background Essential hypertension (EH) is the common cause of left ventricular (LV) geometric remodelling which includes shape remodelling, volume remodelling and mass remodelling. The relation between the type of LV geometric remodelling and atrial fibrillation (AF) in patients with EH was unknown.
Objectives To explore the relation between the type of left ventricular geometric remodelling and AF in patient with EH.
Methods In accordance with hypertension guideline (JNC-7), consecutive inpatients with EH (n=211, from September, 2008 to August, 2009) were enrolled at the department of cardiology in PLA general hospital. The patients were divided into AF group and sinus rhythm (SR) group by baseline heart rhythm. The diagnosis of AF was conformed to ACC/AHA/ESC 2006 guidelines for the management of patients with AF executive summary. The patients underwent Doppler echocardiography examination which included LV sphericity index (LVSI), LV diastolic volume (LVEDV), LV mass (LVM) and left atrial sphericity index (LASI). The clinical and echocardiographic characteristics were compared by t test, Chi-square test and multiple Logistic regression analysis. Then AF group was divided into persistent group and paraxysmal group. The indices of echocardiography among three groups were compared by analysis of variance.
Results Compared to SR group, AF group has lower systolic blood pressure and diastolic blood pressure (138.85±19.89 mm Hg vs 149.80±25.17 mm Hg; 80.57±13.04 mm Hg vs 85.97±15.81 mm Hg, p<0.01) and larger LVM, LVEDV, LVESV and LVSI (108.19±27.52 g vs 99.69±21.61 g, p<0.05; 199.20±57.00 ml vs 181.92±50.62 ml, p<0.05; 45.52±20.03 ml vs 37.60±13.03 ml, p<0.01; 0.715±0.043 vs 0.688±0.040, p<0.01), although LASI was significantly smaller (0.740±0.081 vs 0.779±0.08, p<0.01). Given covariates were adjusted in the logistic regression model, the LVSI, LAD and LASI were independent factors associated with AF in patients with hypertension (OR:0.847, 95% CI 6.141±138.590, p<0.01; OR: 0.811, 95% CI 0.738±0.891, p<0.01; OR: 65.836, 95% CI 0.764±0.942, p<0.01).
Conclusions Compared to SR group, AF group has significant variation in the type of left ventricular geometric remodelling in EH patients. The LVM and LV volume are much larger and there is a sphericity trend of LV in EH patients with AF. However, there is a deviation of sphericity of left atrial in EH patients with AF. The LVSI, LAD and LASI were the independent risk factors of EH patients with AF after adjustment for other covariates. With the development of AF, the degree of left ventricular geometric remodelling is increasing.
- Essential hypertension
- type of left ventricular geometric remodelling
- atrial fibrillation
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