Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg.
Preventive Cardiology and Preventive Medicine, Center for Cardiology.
J Hypertens. 2019 May;37(5):928-934. doi: 10.1097/HJH.0000000000002000.
Arterial stiffness is a strong predictor of atrial fibrillation in the community. Whether noninvasively measured conduit artery function and peripheral vascular reactivity are related to atrial fibrillation remains unknown.
In 15 010 individuals of the population-based Gutenberg Health Study, mean age 55 ± 11 years, 50.5% men, we determined noninvasive vascular function by flow-mediated dilation (FMD) and peripheral arterial tonometry (PAT) in relation to manifest atrial fibrillation (N = 466). Patients with atrial fibrillation exhibited a higher mean brachial artery diameter [4.81 mm (4.17, 5.33) in atrial fibrillation vs. 4.31 mm (3.67, 4.93)] and baseline pulse amplitude in arbitrary units [6.35 (5.76, 6.78) in atrial fibrillation vs. 6.09 (5.36, 6.71)] as well as a reduced FMD in arbitrary units [1.29 (1.26, 1.33) in atrial fibrillation vs. (1.31 (1.26, 1.37)] and PAT ratio [0.42 (0.19, 0.77) in atrial fibrillation vs. 0.67 (0.33, 0.94)] compared with individuals without atrial fibrillation (all PWilcoxon rank-sum test). In age-adjusted and sex-adjusted logistic regression analyses, only baseline brachial artery diameter [odds ratio (OR) per standard deviation 1.19; 95% confidence interval (CI), 1.04-1.37; P = 0.012] and PAT ratio (OR 0.83; 0.74-0.94; P = 0.0029) were associated with atrial fibrillation. In risk factor and heart rate-adjusted models, there was no statistically significant correlation of atrial fibrillation and brachial artery diameter, FMD and PAT ratio while baseline pulse amplitude was reduced in individuals with atrial fibrillation (OR 0.81; 95% CI 0.71-0.93; P = 0.0034).
In our large contemporary cohort, peripheral vascular function was compromised in individuals with atrial fibrillation. However, observed associations were mediated by age and classical risk factors. Noninvasive vascular function measures did not improve discriminatory ability for atrial fibrillation.
动脉僵硬度是社区心房颤动的一个强有力的预测因子。无创测量的导动脉功能和外周血管反应性与心房颤动之间的关系尚不清楚。
在基于人群的哥廷根健康研究的 15010 名个体中，平均年龄为 55±11 岁，50.5%为男性，我们通过血流介导的扩张（FMD）和外周动脉张力测定（PAT）来确定无创血管功能，与显性心房颤动（N=466）有关。心房颤动患者的肱动脉直径[4.81mm（4.17，5.33）与心房颤动相比]和基线脉搏振幅（以任意单位表示）[6.35（5.76，6.78）与心房颤动相比]较高，而 FMD 以任意单位表示[1.29（1.26，1.33）与心房颤动相比]和 PAT 比值[0.42（0.19，0.77）与心房颤动相比]较低（所有 PWilcoxon 秩和检验）。在年龄调整和性别调整的逻辑回归分析中，只有基线肱动脉直径[每标准差 1.19 的优势比（OR）；95%置信区间（CI），1.04-1.37；P=0.012]和 PAT 比值（OR 0.83；0.74-0.94；P=0.0029）与心房颤动相关。在危险因素和心率调整模型中，虽然心房颤动患者的基线脉搏振幅降低，但心房颤动与肱动脉直径、FMD 和 PAT 比值之间没有统计学上的相关性（OR 0.81；95%CI 0.71-0.93；P=0.0034）。
在我们的大型当代队列中，心房颤动患者的外周血管功能受损。然而，观察到的相关性是由年龄和经典危险因素介导的。无创血管功能测量并不能提高心房颤动的鉴别能力。
