肥胖症手术患者心房颤动的患病率及预测因素
Prevalence and predictors of atrial fibrillation among patients undergoing bariatric surgery.
作者信息
Shoemaker M Benjamin, Gidfar Sanaz, Pipilas Daniel C, Tamboli Robyn A, Savio Galimberti Eleonora, Williams D Brandon, Clements Ronald H, Darbar Dawood
机构信息
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA,
出版信息
Obes Surg. 2014 Apr;24(4):611-6. doi: 10.1007/s11695-013-1123-8.
BACKGROUND
While AF is a disease of the elderly, it can occur earlier in the presence of risk factors such as obesity. Bariatric surgery patients are significantly younger and more obese than previously described populations with AF. Therefore, it remains to be determined whether current estimates of the prevalence and predictors for AF remain true in the bariatric surgery population.
METHODS
We performed a cross-sectional analysis of 1,341 consecutive patients who underwent bariatric surgery from January 2008 to October 2012. Baseline characteristics were compared between patients with and without AF. For additional comparison, 176 patients with AF and body mass index (BMI) >40 kg/m(2) were identified from the Vanderbilt AF Registry. A multivariable logistic regression was performed to identify predictors of AF within the bariatric surgery cohort.
RESULTS
The prevalence of AF in the bariatric surgery cohort was 1.9 % (25/1,341). Patients with AF were older (median 56 years (interquartile range [52-64) vs.46 [38-56] years, p < 0.001), were more often male (48 vs. 23 %, p = 0.004), had more comorbidities, but had no difference in BMI (50 kg/m(2) [44-58] vs. 48 [43-54], p = 0.4). In multivariable analysis, the odds of AF increased 2.2-fold by age per decade (95 % CI, 1.4-3.5; p < 0.001) and 2.4-fold by male gender (1.1-5.4, p = 0.03) when adjusted for BMI. BMI was not independently associated with AF (OR 1.15 [95 % CI, 0.98-1.41], p = 0.09).
CONCLUSIONS
The prevalence of AF is 1.9 % among patients undergoing bariatric surgery. Risk of AF was found to increase with age and male gender, but not with higher BMI.
背景
虽然房颤是一种老年疾病，但在存在肥胖等危险因素时可更早发生。接受减肥手术的患者比先前描述的房颤患者群体明显更年轻且更肥胖。因此，目前关于房颤患病率和预测因素的估计在减肥手术人群中是否仍然适用仍有待确定。
方法
我们对2008年1月至2012年10月期间连续接受减肥手术的1341例患者进行了横断面分析。比较了有房颤和无房颤患者的基线特征。为了进行额外比较，从范德比尔特房颤登记处识别出176例房颤且体重指数（BMI）>40kg/m²的患者。进行多变量逻辑回归以确定减肥手术队列中房颤的预测因素。
结果
减肥手术队列中房颤的患病率为1.9%（25/1341）。有房颤的患者年龄更大（中位数56岁[四分位间距52 - 64岁]对46岁[38 - 56岁]，p < 0.001），男性比例更高（48%对23%，p = 0.004），合并症更多，但BMI无差异（50kg/m²[44 - 58]对48[43 - 54]，p = 0.4）。在多变量分析中，调整BMI后，房颤的发生几率每增加十岁增加2.2倍（95%置信区间，1.4 - 3.5；p < 0.001），男性增加2.4倍（1.1 - 5.4，p = 0.03）。BMI与房颤无独立相关性（比值比1.15[95%置信区间，0.98 - 1.41]，p = 0.09）。
结论
减肥手术患者中房颤的患病率为1.9%。发现房颤风险随年龄和男性性别增加，但不随更高的BMI增加。
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