Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
Europace. 2017 Sep 1;19(9):1463-1469. doi: 10.1093/europace/euw225.
The association between anatomical left atrial (LA) remodelling and ventricular diastolic dysfunction (DD) in atrial fibrillation (AF) patients is not well studied. We aimed to examine the effect of DD on anatomic LA remodelling and their relation with ablation outcomes.
In 104 patients (58 ± 10 years, 69% male) referred for AF ablation, LA volume (LAV) was determined by computed tomography. A cutting plane, between the pulmonary vein (PV) ostia and the appendage and parallel to the posterior wall, divided LAV into anterior- (LA-A) and posterior-LA parts. The ratio of LA-A and LAV was defined as the LA asymmetry index (ASI). According to the current guidelines, the presence of DD was evaluated by echocardiography. Regression analysis was used to identify predictors of asymmetry changes and long-term success. Univariate linear regression revealed that ASI is associated with LAV, the presence of DD, and mitral regurgitation. Asymmetry index was higher in patients with DD (n = 35, 62 ± 5 vs. 59 ± 6%, P = 0.013) or mitral regurgitation (n = 67, 61 ± 6 vs. 58 ± 5%, P = 0.025). Multiple linear regression analysis showed that DD (B = 2.6, β = 0.207, 95% confidence interval, CI: 0.167-5.011, P = 0.036) and LAV (B = 0.037, β = 0.211, 95% CI: 0.003-0.071, P = 0.033) were the only factors independently associated with ASI (adjusted r2 = 0.92, F = 6.2, P = 0.003). Regression analysis showed that AF recurrence (33% after 24 months) is associated with asymmetric LA changes, while DD is not.
Left atrial symmetry changes are associated with DD and dilatation. Since DD could cause LA remodelling, appropriate early treatment should be considered for AF patients with DD, before geometrical changes occur.
左心房（LA）解剖结构重构与心房颤动（AF）患者心室舒张功能障碍（DD）之间的关联尚未得到充分研究。本研究旨在探讨 DD 对解剖 LA 重构的影响及其与消融结果的关系。
在 104 名（58±10 岁，69%为男性）因 AF 消融而就诊的患者中，通过计算机断层扫描确定 LA 容积（LAV）。一个切面，在肺静脉（PV）口与心耳之间，并与后侧壁平行，将 LAV 分为前 LA（LA-A）和后 LA 部分。LA-A 与 LAV 的比值定义为 LA 不对称指数（ASI）。根据现行指南，通过超声心动图评估 DD 的存在。回归分析用于确定不对称性变化和长期成功的预测因素。单变量线性回归显示，ASI 与 LAV、DD 及二尖瓣反流相关。存在 DD（n=35，62±5%比 59±6%，P=0.013）或二尖瓣反流（n=67，61±6%比 58±5%，P=0.025）的患者 ASI 更高。多元线性回归分析显示，DD（B=2.6，β=0.207，95%置信区间，CI：0.167-5.011，P=0.036）和 LAV（B=0.037，β=0.211，95%CI：0.003-0.071，P=0.033）是与 ASI 独立相关的唯一因素（调整后的 r2=0.92，F=6.2，P=0.003）。回归分析显示，AF 复发（24 个月后 33%）与不对称性 LA 变化相关，而 DD 则无此相关性。
LA 对称性变化与 DD 和扩张有关。由于 DD 可能导致 LA 重构，因此对于存在 DD 的 AF 患者，应在发生几何结构变化之前考虑进行适当的早期治疗。
