Department of Cardiology, Rambam Medical Center, and Rappaport Faculty of Medicine and Research Institute, Technion, Israel Institute of Technology, Haifa, Israel.
Am J Cardiol. 2011 Jun 15;107(12):1738-43. doi: 10.1016/j.amjcard.2011.02.334. Epub 2011 Apr 15.
Mechanisms for atrial arrhythmias that occur in the context of acute myocardial infarction (AMI) have not been well characterized. AMI often leads to alterations in left ventricular (LV) filling dynamics, which may result in advanced diastolic dysfunction. Diastolic dysfunction may produce increased left atrial (LA) pressure and initiate LA remodeling, promoting the progression to atrial fibrillation (AF). We studied 1,169 patients admitted with AMI. Advanced diastolic dysfunction was defined as a restrictive filling pattern (RFP), defined as ratio of early to late transmitral velocity of mitral inflow >1.5 or deceleration time <130 ms. The relation between RFP and the primary end point of new-onset AF occurring within 6 months was analyzed using multivariable Cox models. Of 1,169 patients (70% men, mean ± SD 64 ± 10 years of age), 110 (9.4%) developed new-onset AF (19.6% and 7.5% in patients with and without RFP, respectively, p <0.0001). RFP was associated with a hazard ratio of 2.72 for AF (95% confidence interval 1.83 to 4.05, p <0.0001). After multivariable adjustments for clinical variables, LV ejection fraction (EF) and LA size, RFP remained an independent predictor of AF (hazard ratio 2.17, 95% confidence interval 1.42 to 3.32, p <0.0001). Risk of AF was higher in patients with RFP for preserved (≥45%, hazard ratio 2.14, 95% confidence interval 1.09 to 4.20, p = 0.03) or decreased (hazard ratio 2.80, 95% confidence interval 1.63 to 4.82, p <0.0001) LVEF. In contrast, decreased LVEF in the absence of RFP was similar to that of patients with preserved LVEF and without RFP. In conclusion, in patients with AMI, presence of advanced diastolic dysfunction was independently associated with new-onset AF, suggesting that increased filling pressures may contribute to the development of AF after AMI.
在急性心肌梗死（AMI）的背景下发生的心房性心律失常的机制尚未得到很好的描述。AMI 常导致左心室（LV）充盈动力学的改变，这可能导致晚期舒张功能障碍。舒张功能障碍可能导致左心房（LA）压力升高并引发 LA 重构，从而促进房颤（AF）的进展。我们研究了 1169 例因 AMI 入院的患者。晚期舒张功能障碍定义为限制性充盈模式（RFP），定义为二尖瓣血流早期与晚期速度比>1.5 或减速时间<130ms。使用多变量 Cox 模型分析 RFP 与 6 个月内新发 AF 的主要终点之间的关系。在 1169 例患者（70%为男性，平均±标准差 64±10 岁）中，110 例（9.4%）发生新发 AF（有 RFP 的患者发生率为 19.6%，无 RFP 的患者发生率为 7.5%，p<0.0001）。RFP 与 AF 的风险比为 2.72（95%置信区间 1.83 至 4.05，p<0.0001）。在对临床变量、LV 射血分数（EF）和 LA 大小进行多变量调整后，RFP 仍然是 AF 的独立预测因素（风险比 2.17，95%置信区间 1.42 至 3.32，p<0.0001）。在 RFP 阳性（≥45%，风险比 2.14，95%置信区间 1.09 至 4.20，p=0.03）或 RFP 阴性（风险比 2.80，95%置信区间 1.63 至 4.82，p<0.0001）但 EF 降低的患者中，AF 的风险更高。相比之下，在没有 RFP 的情况下，EF 降低与 EF 正常且没有 RFP 的患者相似。总之，在 AMI 患者中，晚期舒张功能障碍的存在与新发 AF 独立相关，提示充盈压升高可能导致 AMI 后 AF 的发生。
