Yonsei University Health System, 50-1 Yonseiro, Seodaemun-gu, Seoul, Korea.
Europace. 2018 Aug 1;20(8):1287-1293. doi: 10.1093/europace/eux173.
Circulating adiponectin is known to have anti-diabetic, anti-atherogenic, and anti-inflammatory properties. However, the predictive value of adiponectin in cardiovascular disease has been reported to be contradictory ('adiponectin paradox') and its relationship with atrial fibrillation (AF) is controversial. We hypothesized that pre-procedural plasma level of adiponectin would have prognostic value in patients who underwent AF catheter ablation.
This observational cohort study included 874 patients with paroxysmal AF (PAF) (73.0% male, mean age 57.6 ± 11.2 years) who underwent catheter ablation. Quartile analyses of plasma level of adiponectin were performed to determine AF-related clinical factors. Patients in the highest quartile of plasma adiponectin were more likely to be older (P < 0.001), female (P < 0.001), and have a higher CHA2DS2-VASc score (P < 0.001) than patients in the other three quartiles. Plasma level of adiponectin was independently associated with female gender (B 2.92 [1.84∼4.00], P < 0.001), older age (B 0.06 [0.03∼0.10], P < 0.001), lower body mass index (B - 0.22 [-0.42∼-0.03], P = 0.025), and greater LA volume index (B 0.05 [0.01∼0.08], P = 0.005). During the 29.9 ± 18.0 months of follow-up, plasma adiponectin level (HR 1.17 [1.02∼1.35], P = 0.022) was independently associated with clinical recurrence of AF, and the clinical recurrence rate was significantly higher in the highest quartile of adiponectin group than the others (log rank P = 0.029), especially in age <65 years (log rank P = 0.038), but not in age ≥65.
High circulating adiponectin is independently associated with AF recurrence after catheter ablation for PAF, especially younger than 65 years old.
循环脂联素具有抗糖尿病、抗动脉粥样硬化和抗炎作用。然而，脂联素在心血管疾病中的预测价值一直存在争议（“脂联素悖论”），其与心房颤动（AF）的关系也存在争议。我们假设，在接受 AF 导管消融的患者中，术前血浆脂联素水平具有预后价值。
这项观察性队列研究纳入了 874 名阵发性 AF（PAF）患者（73.0%为男性，平均年龄 57.6±11.2 岁），他们接受了导管消融。对血浆脂联素水平进行四分位分析，以确定与 AF 相关的临床因素。与其他三个四分位组相比，血浆脂联素最高四分位的患者年龄更大（P<0.001）、女性更多（P<0.001）、CHA2DS2-VASc 评分更高（P<0.001）。血浆脂联素水平与女性性别独立相关（B 2.92[1.84∼4.00]，P<0.001）、年龄较大（B 0.06[0.03∼0.10]，P<0.001）、较低的体重指数（B−0.22[−0.42∼−0.03]，P=0.025）和较大的左心房容积指数（B 0.05[0.01∼0.08]，P=0.005）。在 29.9±18.0 个月的随访期间，血浆脂联素水平（HR 1.17[1.02∼1.35]，P=0.022）与 AF 临床复发独立相关，脂联素水平最高四分位组的临床复发率明显高于其他组（对数秩检验 P=0.029），尤其是年龄<65 岁的患者（对数秩检验 P=0.038），但年龄≥65 岁的患者无此差异。
高循环脂联素与 PAF 导管消融后 AF 复发独立相关，尤其是年龄<65 岁的患者。
