| ObjectiveEssential hypertensive patients with left atrial myocardial fibrosis(MF) evaluated by serum fibrotic marker carboxyterminal propeptide of type I procollagen (PICP), By means of observing the changes of echocardiography parameters in these patients, this study was designed to investigate the clinical value of quantitative assessment of MF, and to assess the relationship between several parameters of echocardiography including acoustic densitometry (AD) parameters and the serum markers, relationship between acoustic densitometry (AD) parameters and parameters of left atrial anatomy and left ventricular function in essential hypertensive patients.MethodsEssential hypertensive patients with left atrial myocardial fibrosis were divided by PIP into 2 groups: essential hypertensive group A (essential hypertensive patients with PICP<127 μg/L)(22 patients) and essential hypertensive group B (essential hypertensive patients with PICP>127 μg/L)(32 patients). Additionally, according to the duration of the hypertensive patients, all patients were divided into 3 groups: hypertensive patients with duration of less than 5 years (18 patients), hypertensive patients with duration of 5 to 10 years (17 patients) and hypertensive patients with duration of more than 10 years (19 patients). The serum concentration ofCarboxyterminal propeptide of type I procollagen (PICP), Serum procollagen type III (PCIII) were measured by specific radioimmunoassay. Myocardial ultrasonic backscatter parameters were measured by AD technique in this study. Two-dimensional, M-mode and Doppler ultrasound recordings were obtained in every subject to determine several parameters of the left atrial anatomy , the ventricle anatomy and its function. Results1. PICP concentration was significantly increased (P<0.05) in essential hypertensive group B as compared with essential hypertensive group A and normotensive subjects, But the serum concentration of PICP in essential hypertensive group A and normotensive subjects had no significant difference. PCIII concentration was significantly increased (P<0.05) in essential hypertensive group B and essential hypertensive group A as compared with normotensive subjects, and the serum concentration was higher in essential hypertensive group B than that in essential hypertensive group A (p<0.05).2. (1) All of posterior wall of left atrium was significantly increased (P<0.05) in essential hypertensive group B and essential hypertensive group A as compared with normotensive subjects, and that was higher in essential hypertensive group B than in essential hypertensive group A (p<0.05). No significant difference in All of pericardium and All of atrial chamber existed among the three groups (p>0.05). Corrected Acoustic Intensity (CAI) of PW (All of PW were corrected by All of pericardium or left atrial chamber) was significantly increased (P<0.05) in essential hypertensive group B and essential hypertensive group A as compared with normotensive subjects, and that was higher in essential hypertensive group B than in essential hypertensive group A (p<0.05).(2) PPI (peek to peek intensity) of PW was significantly decreased (P<0.05) in essential hypertensive group B and essential hypertensive group A as compared with normotensive subjects, and that was less in essential hypertensive group B than in essential hypertensive group A (p<0.05). PPI of pericardium were higher in essential hypertensive group B than normotensive subjects (p<0.05), but no significantdifference existed between essential hypertensive group A and essential hypertensive group B or normotensive subjects (p>0.05). No significant difference existed in PPI of left atrial chamber among three groups (p>0.05).4. AII of posterior wall of left atrium was significantly increased (P<0.05) in hypertensive patients with duration of more than 10 years as compared with that in hypertensive patients with duration of 5 to 10 years, significantly increased (p<0.01) than that of hypertensive patients with duration of less than 5 years. AII of posterior wall of left atrium was significantly increased (p<0.01) in hypertensive patients with duration of 5 to 10 years as compared with that in hypertensive patients with duration of less than 5 years. Corrected Acoustic Intensity (CAI) of PW CAI1 (AII of PW were corrected by AII of pericardium,CAI1) and CAI2 (corrected by AII of left atrial chamber,CAI2) in hypertensive patients with duration of more than 10 years were significantly increased(P<0.01) as compared with those in hypertensive patients with duration of 5 to 10 years, significantly increased (p<0.01) than that of hypertensive patients with duration of less than 5 years. CAI1 and CAI2 of posterior wall of left atrium were significantly increased (p<0.01) in hypertensive patients with duration of 5 to 10 years as compared with those in hypertensive patients with duration of less than 5 years and normotensive subjects. AII of pericardium (AII1) and AII of left atria] chamber (AII2) in the three groups had no significant difference, P>0.05.5.LAD was significantly increased (P<0.05) in essential hypertensive group B and essential hypertensive group A as compared with normotensive subjects, and that was higher in essential hypertensive group B than in essential hypertensive group A (p<0.05).6. The ratio of E (mitral valve E wave peak velocity)to A (mitral valve A wave peak velocity) and EVTI/AVTI (the ratio of flow velocity time integral of E and A) were significantly decreased (P<0.05)in essential hypertensive group B and essential hypertensive group A as compared with normotensive subjects, but no significant difference was observed between essential hypertensive group B and essential hypertensive group A. The pulmonary venous flow velocity variables including AVP,S/D, SVTI/DVTI and left ventricular isovolumetric relaxation time (IVRT) were significantly increased (P<0.05) in essential hypertensive group B and essential hypertensive group A as compared with normotensive subjects and that was higher in essential hypertensive group B than essential hypertensive group A (p<0.05)7. AII of PW of left arrium , and those corrected by pericardium and left atial chamber were correlated positively with LAD.8. AII of PW of left arrium , and those corrected by pericardium and left atial chamber were correlated positively with AVP, S/D, IVRT and LVMI.9. AII of PW of left arrium , and those corrected by pericardium and left atial chamber were correlated positively with the serum concentrations of PICP, but that were not correlated with the serum concentrations of PCIII.Conclusion1. AII, CAI and PPI are useful marker in determination of the degree of left atrial myocardial fibrosis in patients with essential hypertension. They can quantitatively assess left atrial myocardial fibrosis.2. The positive relationship between the serum marker PICP and AII, CAI indicates that the increase of collagen type I plays a more important role in the ongoing left atrial MF in essential hypertension patients. CAI can be more accurate in reflecting the changes of left atrial MF than AIL The positive relationship between the serum PICP and AII, CAI indicates that serum markers combined with AD technique can be more accurate in quantitative assessment of left atrial MF in essential hypertension patients.3.The degree of left atrial myocardial fibrosis is affected by LAD duration of hypertension and left ventricular diastolic function.
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