Kim Jin-Seok, Shin Seung Yong, Kang Jun Hyuk, Yong Hwan Seok, Na Jin Oh, Choi Cheol Ung, Kim Seong Hwan, Kim Eung Ju, Rha Seung-Woon, Park Chang Gyu, Seo Hong Seog, Oh Dong Joo, Hwang Chun, Kim Young-Hoon, Lim Hong Euy
Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Division of Cardiology, Heart Research Institute, College of Medicine, Chung-Ang University, Seoul, Korea.
J Am Heart Assoc. 2017 Aug 4;6(8):e006077. doi: 10.1161/JAHA.117.006077.
Epicardial adipose tissue (EAT) is known to play an important role in atrial fibrillation substrate remodeling; however, the influence of sex on the association between EAT and left atrial (LA) transport function has not been elucidated.
Of the 514 patients who underwent an index atrial fibrillation ablation procedure, 123 postmenopausal women with no history of hormone replacement therapy and 123 men who were matched for age, body mass index, type of atrial fibrillation, and CHADS score were enrolled. Before the procedure, LA volume, LA emptying fraction, and EAT volume were assessed using multislice computed tomography. Blood samples were obtained from a coronary sinus for analysis of serum adiponectin level before the ablation procedure. There were no differences in baseline demographics and laboratory findings between sexes. Compared with men, women had significantly less total EAT (<0.001) and higher serum adiponectin levels (=0.022) but higher proportions of periatrial EAT to total EAT volume (P/T EAT ratio, <0.001), lower LA emptying fraction (=0.042), and lower LA voltage (=0.034). The ratio of periatrial to total EAT volume correlated significantly with LA emptying fraction and LA voltage in both sexes, whereas total EAT volume and serum adiponectin level did not. On multivariate analysis, increased LA volume and higher periatrial:total EAT volume ratio were independent predictors of decreased LA emptying fraction in both sexes.
Compared with matched men, postmenopausal women with atrial fibrillation had higher periatrial adiposity, which was independently correlated with decreased LA voltage and LA transport function.
已知心外膜脂肪组织（EAT）在心房颤动基质重塑中起重要作用；然而，性别对EAT与左心房（LA）转运功能之间关联的影响尚未阐明。
在514例行初次心房颤动消融手术的患者中，纳入123例无激素替代治疗史的绝经后女性以及123例年龄、体重指数、心房颤动类型和CHADS评分相匹配的男性。在手术前，使用多层计算机断层扫描评估LA容积、LA排空分数和EAT容积。在消融手术前从冠状窦采集血样以分析血清脂联素水平。男女之间的基线人口统计学和实验室检查结果无差异。与男性相比，女性的总EAT显著更少（<0.001）且血清脂联素水平更高（=0.022），但心房周围EAT占总EAT容积的比例更高（P/T EAT比值，<0.001），LA排空分数更低（=0.042），LA电压更低（=0.034）。心房周围与总EAT容积的比值在男女中均与LA排空分数和LA电压显著相关，而总EAT容积和血清脂联素水平则不然。多因素分析显示，LA容积增加和心房周围：总EAT容积比值升高是男女LA排空分数降低的独立预测因素。
与匹配的男性相比，患有心房颤动的绝经后女性心房周围脂肪增多，这与LA电压降低和LA转运功能降低独立相关。
