| Objective: To explore a simple and effective method for measuring cardiac function by echocardiography in patients with atrial fibrillation in Tibetan areas at high altitude,and to study whether Tibetan hypertension is complicated with atrial fibrillation and the difference of cardiac ultrasound parameters in patients with different types of atrial fibrillation in Tibetan areas;To explore the risk factors of atrial fibrillation,to study the relationship between the laboratory indicators in the risk factors and the parameters of echocardiography,and to explore the predictive value of their combined ultrasound observation indicators for the occurrence of atrial fibrillation in the Tibetan hypertensive population.Method: 60 patients with hypertension and atrial fibrillation who were hospitalized in the People’s Hospital of Tibet Autonomous Region from July 2021 to December 2022 were selected as the study group,and60 patients with hypertensive sinus rhythm in the same period were selected as the control group,The paired sample t-test was used to explore and verify the consistency of the results of the ejection fraction obtained by the single cardiac cycle measurement method and the average value measurement method of 13 consecutive cardiac cycle measurements immediately after the ratio of RR1/RR2 was close to 1,analyzing the differences and influencing factors of echocardiography observation data between hypertensive patients with atrial fibrillation and simple hypertensive patients,and explore the value of the combination of ultrasonic parameters and other influencing factors in predicting the occurrence of atrial fibrillation;60 patients in the selected atrial fibrillation group were grouped according to different types of atrial fibrillation,and the differences in echocardiography parameters of hypertensive patients with different types of atrial fibrillation were analyzed;Chi-square test,independent sample t-test and nonparametric test were used to compare the relevant observation indexes and parameters of whether atrial fibrillation occurred,and Logistic was used to analyze the risk factors of atrial fibrillation,compare the differences of echocardiography in patients with atrial fibrillation,and draw ROC curve to evaluate the predictive value of echocardiography parameters on whether atrial fibrillation occurred in Tibetan patients with high blood pressure;Independent sample t-test and chi-square test were used to compare the echocardiographic parameters of patients with different types of atrial fibrillation,and evaluate the differences of different ultrasonic observation parameters in paroxysmal atrial fibrillation or persistent and permanent atrial fibrillation.Results: The analysis results show that the ejection fraction of single cardiac cycle measurement method and the average value of continuous cardiac cycle measurement method are consistent in the echocardiographic examination of Tibetan people with atrial fibrillation at high altitude(KAPPA=0.67 P<0.05),the ventricular septal thickness(P<0.05),left ventricular end-diastolic diameter(P<0.05),left atrial diameter(P<0.001),early diastolic mitral flow velocity/early diastolic mitral annular motion velocity(P<0.05)were significantly different between Tibetan hypertensive patients with atrial fibrillation and those without atrial fibrillation,there was no statistically significant difference between the occurrence of atrial fibrillation and the absence of atrial fibrillation in Tibetan hypertensive patients between the ventricular septal thickness/left ventricular posterior wall thickness,right ventricular internal diameter,ejection fraction,and left ventricular outflow tract velocity time integral,among the laboratory indicators of Tibetan hypertensive patients,there were statistically significant differences in age(P<0.001),uric acid(P<0.05)and low density lipoprotein cholesterol(P<0.05)between patients with and without atrial fibrillation,Age(P<0.05),low density lipoprotein cholesterol(P<0.05),ventricular septal thickness(P<0.05)and left atrial diameter(P<0.001)are risk factors for atrial fibrillation in Tibetan hypertensive patients.The ventricular septal thickness(critical value 11.5mm,sensitivity 65%,specificity 61.7%)and left atrial diameter(critical value 43.5mm,sensitivity 90%,specificity66.7%)have predictive value for the occurrence of atrial fibrillation in Tibetan hypertensive patients.By analyzing the ventricular septum,ventricular septum thickness/left ventricular posterior wall thickness,left ventricular end diastolic diameter,right ventricular diameter,left atrial diameter,ejection fraction,left ventricular outflow tract velocity time integral,early diastolic mitral flow velocity/early diastolic mitral annular motion velocity of patients with different types of atrial fibrillation,we found that there were significant differences in left atrial diameter(P<0.05),ejection fraction(P<0.05),left ventricular outflow tract velocity time integral(P<0.05),early diastolic mitral flow velocity/early diastolic mitral annular motion velocity(P<0.05)between Tibetan hypertensive patients with paroxysmal atrial fibrillation and Tibetan hypertensive patients with persistent or permanent atrial fibrillation.Conclusion: The single heart beat measurement method based on RR1/RR2 close to 1 is simple and effective for measuring the ejection fraction of echocardiography in Tibetan hypertensive patients with atrial fibrillation.There are significant differences in the echocardiographic parameters between Tibetan hypertensive patients with atrial fibrillation and hypertensive patients without atrial fibrillation in the ventricular septal thickness,left ventricular end-diastolic diameter,left atrial diameter,early diastolic mitral flow velocity/early diastolic mitral annular motion velocity,among the laboratory examination indexes and echocardiographic parameters of Tibetan hypertensive patients,age,low density lipoprotein cholesterol,ventricular septal thickness and left atrial diameter are risk factors for atrial fibrillation.At the same time,left atrial diameter,ejection fraction,left ventricular outflow tract velocity time integral,early diastolic mitral flow velocity/early diastolic mitral annular motion velocity were different between Tibetan hypertensive patients with paroxysmal atrial fibrillation and Tibetan hypertensive patients with persistent atrial fibrillation or permanent atrial fibrillation,It is speculated that myocardial remodeling is not only conducive to the occurrence of atrial fibrillation in Tibetan hypertensive patients,but also conducive to the maintenance of atrial fibrillation in Tibetan hypertensive patients.Ultrasonic examination of ventricular septal thickness,left atrial diameter increase,especially left atrial diameter,has high predictive value for atrial fibrillation in Tibetan hypertensive patients. |
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