Hypertension and hypertensive heart disease are associated with increased ostial pulmonary vein diameter.
BACKGROUND
Atrial fibrillation (AF) is associated with increased ostial pulmonary vein (PV) diameter and commonly with hypertension. We sought to investigate ostial PV anatomy in patients with and without AF with the goal of characterizing the relationship to hypertension and cardiovascular disease.


RESULTS
Ostial PV diameter was assessed by preprocedural spiral computed tomography in 100 AF patients undergoing a PV isolation procedure and in 24 age- and sex-matched non-AF control patients. Ostial diameter of 392 PVs in 100 AF patients was increased compared to 106 PVs in 24 non-AF controls (1.50 +/- 0.31 vs 1.20 +/- 0.31 cm, P <0.001) and diameters of individual PVs were uniformly affected (r=0.45-0.62, P <0.001). Left atrial dilation was associated with a larger PV diameter (1.56 +/- 0.32 vs 1.44 +/- 0.29 cm, P <0.01). PV diameter in AF patients with hypertension (1.55 +/- 0.32 cm), particularly if associated with left ventricular hypertrophy (1.66 +/- 0.37 cm), was larger compared to AF patients without hypertension (1.43 +/- 0.26 cm, P <0.01). PV diameter in control patients with hypertension (n=14) was larger than in those without hypertension (n=10, P <0.01). Patients with persistent AF had larger PV diameters (1.61 +/- 0.34 cm) than patients with paroxysmal AF (1.47 +/- 0.30 cm, P <0.01). Male gender (P <0.01), history of hypertension (P <0.01), and persistent AF (P <0.05) were identified as independent cofactors of increased ostial PV diameter.


CONCLUSIONS
PV dilation affects all PVs uniformly in AF patients. Hypertension and hypertensive heart disease in patients with and without AF are associated with PV dilation, supporting theories that impaired left ventricular diastolic function is associated with a stretch-induced PV arrhythmia mechanism.
Herweg
Bengt
B
Arrhythmia Service and Division of Cardiology, St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York 10025, USA.
Sichrovsky
Tina
T
Polosajian
Leo
L
Rozenshtein
Anna
A
Steinberg
Jonathan S
JS
D019412:Anatomy, Cross-Sectional / Q000379:methods; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D004108:Dilatation, Pathologic; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000473:pathology; D011859:Radiography; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016037:Single-Blind Method; D013223:Statistics as Topic