From the Department of Neurology, Institute of Molecular Medicine (A.C.F., P.N.A., T.P.M., J.M.F.), University of Lisboa, Portugal.
Department of Neurology, Hospital Egas Moniz, Lisboa, Portugal (J.P.M., M.V.-B.).
Stroke. 2018 Nov;49(11):2584-2589. doi: 10.1161/STROKEAHA.118.022105.
Background and Purpose- Women with atrial fibrillation (AF) have a higher risk of stroke than men who have AF. Atrial fibrosis is a marker of atrial disease that precedes the appearance of AF increasing the risk of ischemic stroke. We aimed to determine whether female sex is independently associated with left atrial fibrosis in stroke patients. Methods- We prospectively included a consecutive sample of ischemic stroke patients aged over 50 years of age. Late gadolinium enhancement cardiac magnetic resonance imaging was performed to quantify the severity of left atrial fibrosis and the wall pattern of its distribution. A multivariable linear regression analysis was performed to determine whether female sex was independently associated with left atrial fibrosis after adjusting for potential confounders namely AF and age. Results- One hundred twenty-four patients were deemed eligible; 117 patients were included (7 were excluded because of cardiomyopathy identified by cardiac magnetic resonance imaging). All had usable cardiac magnetic resonance imaging data. Fifty-three patients (45.3%) were women. Women were older and were less frequently treated with angiotensin-converting-enzyme inhibitors. Ninety-one patients had any degree of atrial fibrosis. Women had a higher percentage of atrial fibrosis than men-median (interquartile range)-18% (17) versus 10% (20). In a multivariable linear regression model adjusted for demographics, medications, AF, comorbidities, and cardiac parameters, female sex was found to be independently associated with left atrial fibrosis. Women were found to have more 4.70% of left atrial fibrosis than men (95% CI, 0.70-8.71%; P=0.02) after controlling for confounders. Conclusions- Female sex was found to be independently associated with left atrial fibrosis after controlling for confounders such as AF and age. Further studies are needed to understand if this contributes to the increased stroke risk related to AF in women compared with men.
背景与目的-患有心房颤动（AF）的女性发生卒中的风险高于患有 AF 的男性。心房纤维化是一种心房疾病的标志物，它先于 AF 的出现，增加了缺血性卒中的风险。我们旨在确定女性性别是否与卒中患者的左心房纤维化独立相关。
方法-我们前瞻性纳入了年龄大于 50 岁的连续缺血性卒中患者样本。进行心脏磁共振钆延迟增强成像以定量评估左心房纤维化的严重程度及其分布的壁模式。多变量线性回归分析用于确定在调整潜在混杂因素（即 AF 和年龄）后，女性性别是否与左心房纤维化独立相关。
结果-124 例患者被认为符合条件；117 例患者被纳入（7 例因心脏磁共振成像确定的心肌病而被排除在外）。所有患者均有可用于心脏磁共振成像的数据。53 例（45.3%）患者为女性。女性年龄较大，且较少接受血管紧张素转换酶抑制剂治疗。91 例患者存在任何程度的心房纤维化。女性的心房纤维化程度高于男性-中位数（四分位距）-18%（17）比 10%（20）。在调整人口统计学、药物、AF、合并症和心脏参数的多变量线性回归模型中，发现女性性别与左心房纤维化独立相关。在控制混杂因素后，女性的左心房纤维化程度比男性高 4.70%（95%置信区间，0.70-8.71%；P=0.02）。
结论-在控制 AF 和年龄等混杂因素后，发现女性性别与左心房纤维化独立相关。需要进一步研究以了解这是否导致女性 AF 相关卒中风险高于男性。
