Hanna Ibrahim R, Heeke Brian, Bush Heather, Brosius Lynne, King-Hageman Diane, Beshai John F, Langberg Jonathan J
Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia, USA.
J Am Coll Cardiol. 2006 Apr 18;47(8):1683-8. doi: 10.1016/j.jacc.2005.11.068. Epub 2006 Mar 29.
This study sought to determine the influence of stature on atrial fibrillation (AF) in high-risk patients with reduced left ventricular (LV) systolic function.
Left atrial (LA) enlargement is a potent risk factor for AF. Because LA size is strongly associated with stature, we hypothesized that height and body surface area (BSA) are risk factors for AF, independent of other known associations.
Data were obtained from ADVANCENT, a multicenter registry of patients with impaired LV function. Height and BSA were divided into quartiles by gender. Statistical analysis was done using the Cochran Mantel-Haenszel statistic, and multivariable logistic regressions were used to adjust for the effects of known confounders on the association between stature and AF.
A total of 25,268 patients were enrolled. The mean age was 66 years, and the cohort consisted mostly of white men (72%) and patients with ischemic cardiomyopathy (72%). The mean left ventricular ejection fraction was 31%. A history of AF was present in 7,027 patients (27.8%). The AF prevalence increased significantly between the lowest and highest quartiles for height (32% relative increase, p < 0.0001). In the multivariable analysis, the effect of height on AF risk persisted after adjusting for age, gender, race, left ventricular ejection fraction, heart failure class and etiology, hypertension, diabetes, and medication use (odds ratio 1.026/cm, 95% confidence interval [CI] 1.022 to 1.030). In the multivariable analysis, BSA was also an independent predictor of AF risk (odds ratio 4.221/m2, 95% CI 3.358 to 5.306).
In patients with LV dysfunction, increasing stature portends a higher risk of AF independent of other traditional risk factors for the arrhythmia. This association seems to account for the higher prevalence of AF in men and may be useful for identification of a high-risk population.
本研究旨在确定身高对左心室（LV）收缩功能降低的高危患者房颤（AF）的影响。
左心房（LA）增大是房颤的一个重要危险因素。由于LA大小与身高密切相关，我们假设身高和体表面积（BSA）是房颤的危险因素，独立于其他已知关联因素。
数据来自ADVANCENT，这是一个关于LV功能受损患者的多中心注册研究。身高和BSA按性别分为四分位数。使用 Cochr an Mantel-Haenszel统计量进行统计分析，并使用多变量逻辑回归来调整已知混杂因素对身高与房颤关联的影响。
共纳入25268例患者。平均年龄为66岁，队列主要由白人男性（72%）和缺血性心肌病患者（72%）组成。平均左心室射血分数为31%。7027例患者（27.8%）有房颤病史。身高最低和最高四分位数之间的房颤患病率显著增加（相对增加32%，p<0.0001）。在多变量分析中，调整年龄、性别、种族、左心室射血分数、心力衰竭分级和病因、高血压、糖尿病和药物使用后，身高对房颤风险的影响仍然存在（比值比1.026/cm，95%置信区间[CI]1.022至1.030）。在多变量分析中，BSA也是房颤风险的独立预测因素（比值比4.221/m²，95%CI 3.358至5.306）。
在LV功能障碍患者中，身高增加预示着房颤风险更高，独立于该心律失常的其他传统危险因素。这种关联似乎可以解释男性房颤患病率较高的原因，可能有助于识别高危人群。
