Chalazan Brandon, Dickerman Deanna, Sridhar Arvind, Farrell Maureen, Gayle Katherine, Samuels David C, Shoemaker Benjamin, Darbar Dawood
Department of Medicine, University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois.
Departments of Medicine and Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee.
Am J Cardiol. 2018 Jul 15;122(2):235-241. doi: 10.1016/j.amjcard.2018.04.011. Epub 2018 May 1.
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity and increased mortality. As body mass index (BMI) is increasingly recognized as an important risk factor for the development of AF, we tested the hypothesis that BMI modulates symptomatic AF burden. Cross-sectional data collected from 1,382 patients in the Vanderbilt AF Registry were analyzed. AF severity was assessed using the Toronto atrial fibrillation severity scale (AFSS). BMI was categorized according to World Health Organization guidelines and patients were grouped according to their present AF treatment regimen: no treatment (n = 185), rate control therapy with atrioventricular nodal blocking agents (n = 351), rhythm control with antiarrhythmic drugs (n = 636), and previous AF ablation (n = 210). Patients with BMI >35 kg/m had higher AFSS scores than those with BMI <30 kg/m in the rate control (43.57 vs 38.21: p = 0.0057), rhythm control (46.61 vs 41.08: p = 1.6 × 10), and ablation (44.01 vs 39.02: p = 0.047) groups. Inunivariate linear models, BMI was associated with an increase in the AFSS score in the rate control (0.27, 95% confidence interval [CI] 0.05 to 0.5, p = 0.02), rhythm control (0.38, 95% CI 0.21 to 0.56, p = 2.49 × 10), and ablation (0.38, 95% CI 0.03 to 0.73, p = 0.03) groups. The association remained significant in the rhythm control groups after adjusting for age, gender, race, and comorbidities (0.29, 95% CI 0.11 to 0.49, p = 0.002). In conclusion, increasing BMI was directly associated with patient reported measures of AF symptom severity, burden, and quality of life. This was most significant in patients treated with rhythm-control strategies.
心房颤动（AF）是最常见的持续性心律失常，与显著的发病率和死亡率增加相关。由于体重指数（BMI）越来越被认为是AF发生的重要危险因素，我们检验了BMI调节症状性AF负担的假设。分析了从范德比尔特AF登记处的1382名患者收集的横断面数据。使用多伦多房颤严重程度量表（AFSS）评估AF严重程度。根据世界卫生组织指南对BMI进行分类，并根据患者目前的AF治疗方案进行分组：未治疗（n = 185）、使用房室结阻滞剂进行心率控制治疗（n = 351）、使用抗心律失常药物进行节律控制（n = 636）以及既往AF消融术（n = 210）。在心率控制组（43.57对38.21：p = 0.0057）、节律控制组（46.61对41.08：p = 1.6×10）和消融组（44.01对39.02：p = 0.047）中，BMI>35 kg/m²的患者AFSS评分高于BMI<30 kg/m²的患者。在单变量线性模型中，在心率控制组（0.27，95%置信区间[CI]0.05至0.5，p = 0.02）、节律控制组（0.38，95%CI 0.21至0.56，p = 2.49×10）和消融组（0.38，95%CI 0.03至0.73，p = 0.03）中，BMI与AFSS评分增加相关。在调整年龄、性别、种族和合并症后，节律控制组中的这种关联仍然显著（0.29，95%CI 0.11至0.49，p = 0.002）。总之，BMI增加与患者报告的AF症状严重程度、负担和生活质量测量值直接相关。这在采用节律控制策略治疗的患者中最为显著。
