Geometric And Functional Remodeling As Well As Its Influential Factors Of Atherosclerotic Coronary Arteries And Left Heart In Hypertension And Atrial Fibrillation

Aim: To investigate the geometric and functional remodeling of coronary artery and left heart in coronary heart disease, essential hypertension (EH) and atrial fibrillation (AF) patients. The factors relating to remodeling were also studied. Methods: 1, Atherosclerotic coronary arteries were examined with intravascular ultrasound. Total vessel area (TVA), lumen area (LA), maximal and minimal diameters of the vessels, circumferential lesion range, plaque area and percent lumen stenosis were measured and calculated. The characteristics of lesion including soft and hard plaque, eccentric and concentric stenosis were investigated. 2, Patients with EH and AF were randomized into different groups according to the study objectives. Left ventricular end-diastolic long diameter (LVLD), Left ventricular short diameter in the apex four chamber view (LVSD), left ventricular end diastolic diameter (LVEDD), intraventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), IVST/LVPWT, left ventricular mean short diameter (LVMSD), LVSD/LVLD, LVMSD/LVMLD, left atrial anterior-posterior diameter (LAAPD), 1 eft atrial long diameter (LAL) and short diameter (LAD) , left atrial area (LAA) , left ventricular end systolic volume( ESV ) , left ventricular end diastolic volume (EDV ) , left ventricular stroke volume ( SV ), left ventricular ejection fraction(EF), early-diastolic peak velocity(EPV) , atrial peak velocity (APV) , EPV/APV, left ventricular mass index (LVMI), and relative wall thickness (RWT) were measured or calculated and statistically analyzed. Results: 1, TVA increased with the increment of PA. TVA enlarged 2.09mm corresponding to every 1mm~2 increment of PA in coronanes with stenosis <50%. There was a positive correlation between TVA and circumferential lesion range. TVA and PA were correlated positively in eccentric stenosis segments. No correlation was found between these two areas in concentric stenosis segments. 2, LVSD, LVMSD, LVLD, LVSD/LVLD,LVMSD/LVMLD and LVMI in EH patients were larger than those in normotensives. LVLD, LAD, LVEDD, LVSD/LVLD, and LVMI i n 1 ong-lasting EH were larger than those in short-lasting EH, newly onset EH and normotensives. Newly onset EH had larger IVST, LVPWT, LVMI than normotensives. EH patients with concentric hypertrophy had larger LVEDD, LVMD, IVST/LVPWT, LVLD, LVMD/LVL than EH patients with concentric remodeling and normotensives. Geometric and functional remodeling variables in normotensives, concentric remodeling and concentric hypertrophy EH patients were worsened sequentially. EH patients without remodeling also had lager IVST, LVPWT, LVEDD, LVMI, LAD, LAL, LAAPD and LAA, but smaller EPV/APV ratio than nomortensives. The left ventricles were remodeled differently in patients with isolated systolic hypertension, with isolated diastolic hypertension and with both systolic and diastolic hypertension SDH patients. There was a significant difference in the proportion of left ventricular remodeling patterns between elderly and no-elderly newly-onset EH patients. Patients with lone atrial fibrillation had larger LVSD, LVEDD, LVSD/LVLD, IVST, LVPWT, IVST/LVPWT and LVMI than normal controls. Geometric and functional remodeling variables in EH patient with atrial fibrillation were worse than those in EH patients without atrial fibrillation and in patients with lone atrial fibrillation. Conclusions: 1, Atherosclerotic coronary arteries underlie remodeling and the extent of remodeling are different with different lesion characteristics. 2, The extent of change was different between different geometric remodeling variables. The remodeling of geometric and functional parameters shows different time sequence. Patients with different patterns of left ventricular remodeling have different geometric and functional remodeling extent. The left heart remodeling in different systolic and/or diastolic hypertension patients is not the same. The proportion of remodeling patterns differs significantly between elderly EH patients and no-elderly newly-onset EH patients. There is left ventricular remodeling in lone atrial fibrillation patients. Both geometric and functional remodeling are different between patients with different atrial fibrillation etiology.