Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY, USA.
Department of Biostatistics, Columbia University, New York, NY, USA.
Eur Heart J Cardiovasc Imaging. 2018 Oct 1;19(10):1157-1164. doi: 10.1093/ehjci/jex236.
General obesity, defined by increased body mass index (BMI), is associated with left atrial (LA) enlargement, a marker of cardiovascular risk in the general population. The association between abdominal adiposity, defined by increased waist circumference (WC) or waist-to-hip ratio (WHR), and LA phasic volumes and reservoir function is not well known. The aim of this study was to evaluate the association between different body size metrics and LA phasic volumes and reservoir function in the elderly.
Participants from the CABL (Cardiovascular Abnormalities and Brain Lesions) study underwent measurement of BMI, WC, and WHR. The LA maximum (LAVmax) and minimum (LAVmin) volumes, and LA reservoir function, measured as total emptying volume index (LAEVI), total emptying fraction (LAEF), and expansion index (LAEI), were assessed by real-time 3D echocardiography. The study population included 629 participants (mean age 71 ± 9 years, 61% women). Mean BMI was 27.9 ± 4.6 kg/m2, WC was 95.0 ± 11.7 cm, WHR was 0.91 ± 0.08. After adjusting for multiple potential confounders (demographics, cardiovascular risk factors, left ventricular mass index, and diastolic function), higher WC was significantly associated with higher LA phasic volumes (LAVmax, β = 0.10, P = 0.007 and LAVmin, β = 0.12, P = 0.002) and reduced reservoir function (LAEVI, β = -0.15, P = 0.001 and LAEI, β = -0.09, P = 0.027). WHR was significantly associated only with reduced reservoir function (LAEVI, β = -0.11, P = 0.012), whereas BMI was not associated with either LA phasic volumes or reservoir function.
In the elderly, WC may have more impact on LA phasic volumes and reservoir function, and therefore risk for cardiovascular events, than WHR and BMI.
一般肥胖症是通过增加身体质量指数（BMI）来定义的，它与左心房（LA）扩大有关，这是一般人群心血管风险的一个标志物。腹部肥胖症（通过增加腰围（WC）或腰臀比（WHR）来定义）与 LA 相位容积和储备功能之间的关系尚不清楚。本研究的目的是评估不同身体尺寸指标与老年人 LA 相位容积和储备功能之间的关系。
CABL（心血管异常和脑损伤）研究的参与者接受了 BMI、WC 和 WHR 的测量。通过实时 3D 超声心动图评估 LA 最大（LAVmax）和最小（LAVmin）容积以及 LA 储备功能，测量总排空容积指数（LAEVI）、总排空分数（LAEF）和扩张指数（LAEI）。研究人群包括 629 名参与者（平均年龄 71±9 岁，61%为女性）。平均 BMI 为 27.9±4.6kg/m2，WC 为 95.0±11.7cm，WHR 为 0.91±0.08。在调整了多个潜在混杂因素（人口统计学、心血管危险因素、左心室质量指数和舒张功能）后，较高的 WC 与较高的 LA 相位容积（LAVmax，β=0.10，P=0.007 和 LAVmin，β=0.12，P=0.002）和储备功能降低（LAEVI，β=-0.15，P=0.001 和 LAEI，β=-0.09，P=0.027）显著相关。WHR 仅与储备功能降低相关（LAEVI，β=-0.11，P=0.012），而 BMI 与 LA 相位容积或储备功能均无关。
在老年人中，WC 对 LA 相位容积和储备功能的影响可能大于 WHR 和 BMI，因此对心血管事件的风险更大。
