Copenhagen City Heart Study, Copenhagen, Denmark; Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Copenhagen City Heart Study, Copenhagen, Denmark; Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
JACC Cardiovasc Imaging. 2019 Jun;12(6):981-989. doi: 10.1016/j.jcmg.2017.12.016. Epub 2018 Feb 14.
This study sought to investigate whether left atrial (LA) functional measures predict atrial fibrillation (AF) in the general population.
Increasing evidence suggests LA functional measures are predictors of AF in several patient groups.
In a community-based cohort study, approximately 2,000 individuals underwent a transthoracic echocardiogram. Conventional echocardiographic measures and extended LA measures, including the minimal and maximal LA volumes (LAV and LAV, respectively) and left atrial emptying fraction (LAEF), were performed. The endpoint was incident AF, and participants with known AF were excluded, which left 1,951 for inclusion.
Over 11.0 years of follow-up, 184 (9.4%) developed AF. Those who developed AF had significantly larger LA volumes and lower LAEF than participants free of AF. These LA measures were univariable predictors of AF (LAV hazard ratio [HR]: 1.10 [95% confidence interval (CI): 1.08 to 1.12] per 1-ml increase, p < 0.001; LAV HR: 1.14 [95% CI: 1.12 to 1.16] per 1-ml increase, p < 0.001; LAEF HR: 1.03 [95% CI: 1.02 to 1.04] per percent decrease, p < 0.001). All LA measures remained predictors independent of clinical risk scores, with LAV providing the highest C-statistics when added to these risk scores (C-statistic for CHADS 0.728 vs. CHADS + LAV 0.778; C-statistic for CHARGE-AF 0.815 vs. CHARGE-AF + LAV 0.830). However, hypertension modified the relationship between the measures of LA function (both LAV and LAEF) and risk of AF (p for interaction < 0.001), which was not the case for LAV (p = 0.22). The measures of LA function mainly provided prognostic information regarding risk of AF in participants without hypertension. Even when we restricted our analysis to individuals without hypertension and nondilated LA (LAV<34 ml/m), the LAV and LAEF remained significantly independent predictors of AF after multivariable adjustments (LAV HR: 1.12 [95% CI: 1.01 to 1.24], p = 0.028, and LAEF HR: 1.03 [95% CI: 1.00 to 1.06], p = 0.021, respectively).
LA functional measures predict AF in the general population and provide prognostic information incremental to clinical risk scores. In individuals without hypertension and nondilated LA, these measures indicate an increased risk of AF.
本研究旨在探讨左心房（LA）功能指标是否可预测普通人群中的心房颤动（AF）。
越来越多的证据表明，LA 功能指标可预测多种患者群体中的 AF。
在一项基于社区的队列研究中，约 2000 名个体接受了经胸超声心动图检查。进行了常规超声心动图指标和扩展的 LA 指标（包括最小和最大 LA 容积（LAV 和 LAV，分别）和 LA 排空分数（LAEF））。终点为新发 AF，排除已知 AF 的参与者，纳入 1951 名参与者。
在 11.0 年的随访期间，有 184 名（9.4%）发生了 AF。与无 AF 的参与者相比，发生 AF 的患者的 LA 容积明显更大，LAEF 更低。这些 LA 指标是 AF 的单变量预测因素（LAV 危险比 [HR]：每增加 1 毫升增加 1.10 [95%置信区间（CI）：1.08 至 1.12]，p<0.001；LAV HR：每增加 1 毫升增加 1.14 [95% CI：1.12 至 1.16]，p<0.001；LAEF HR：每降低 1%增加 1.03 [95% CI：1.02 至 1.04]，p<0.001）。所有 LA 指标在独立于临床风险评分的情况下仍然是预测因素，LAV 增加时这些风险评分的 C 统计量最高（CHADS 评分的 C 统计量为 0.728 比 CHADS+LAV 评分的 0.778；CHARGE-AF 评分的 C 统计量为 0.815 比 CHARGE-AF+LAV 评分的 0.830）。然而，高血压改变了 LA 功能指标（LAV 和 LAEF）与 AF 风险之间的关系（交互作用的 p 值<0.001），而对于 LAV 则并非如此（p=0.22）。LA 功能指标主要为无高血压的参与者提供了关于 AF 风险的预后信息。即使我们将分析仅限于无高血压和 LA 不扩张（LAV<34 ml/m）的个体，在多变量调整后，LAV 和 LAEF 仍然是 AF 的显著独立预测因素（LAV HR：1.12 [95% CI：1.01 至 1.24]，p=0.028，和 LAEF HR：1.03 [95% CI：1.00 至 1.06]，p=0.021）。
LA 功能指标可预测普通人群中的 AF，并提供临床风险评分之外的预后信息。在无高血压和 LA 不扩张的个体中，这些指标表明 AF 的风险增加。
