左心房大小和总心房排空分数在心房颤动进展中的作用。
Left atrial size and total atrial emptying fraction in atrial fibrillation progression.
机构信息
Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
Department of Cardiac Surgery, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany.
出版信息
Heart Rhythm. 2019 Nov;16(11):1605-1610. doi: 10.1016/j.hrthm.2019.06.014. Epub 2019 Jun 20.
BACKGROUND
Left atrial (LA) size and low-voltage areas (LVA) mirror atrial fibrillation (AF) progression. Whether these factors are important for the impairment of total atrial emptying fraction is understudied.
OBJECTIVE
The aim of the present analysis was to investigate the association between LA volume and total atrial emptying fraction with AF progression phenotypes: persistent AF and LVA.
METHODS
Patients undergoing first AF ablation were included in the analysis. LVA were determined using high-density maps and defined as <0.5 mV. All patients underwent cardiovascular magnetic resonance imaging before the intervention. Cardiovascular magnetic resonance data (LA volume, LA emptying fraction [LA-EF], and right atrial emptying fraction [RA-EF]) were measured in all patients.
RESULTS
The study population included 211 patients (65 ± 11 years; 124 (59%) men; 122 (58%) persistent AF; 54 (26%) LVA). There were 4 disease progression groups: paroxysmal AF without LVA, paroxysmal AF with LVA, persistent AF without LVA, and persistent AF with LVA. While LA volume increased according to the AF progression phenotype (98 ± 27, 145 ± 34, 134 ± 41, 141 ± 39 mL, respectively; P < .001), total LA-EF (51% ± 17%, 32% ± 17%, 33% ± 17%, 22% ± 11%; P < .001) and RA-EF (47% ± 13%, 36% ± 17%, 30% ± 16%, 23% ± 12%; P < .001) decreased. In multivariable analysis, age (odds ratio [OR] 1.084; 95% confidence interval [CI] 1.028-1.142; P = .003), persistent AF (OR 3.478; 95% CI 1.117-10.830; P = .031), and total LA-EF (OR 0.933; 95% CI 0.899-0.968; P < .001) showed a significant association for LVA. Using receiver operating characteristic curve analysis, LA-EF (area under the curve 0.778; 95% CI 0.711-0.846; P < .001) and RA-EF (area under the curve 0.726; 95% CI 0.650-0.802; P < .001) were significantly associated with the absence of LVA.
CONCLUSION
LVA and persistent AF are associated with worse total atrial emptying fraction.
背景
左心房（LA）大小和低电压区（LVA）反映了心房颤动（AF）的进展。这些因素是否对总心房排空分数的损害很重要，目前研究较少。
目的
本分析的目的是研究 LA 容积和总心房排空分数与 AF 进展表型（持续性 AF 和 LVA）之间的关系。
方法
纳入首次接受 AF 消融的患者进行分析。使用高密度图谱确定 LVA，并定义为<0.5 mV。所有患者均在干预前进行心血管磁共振成像检查。对所有患者进行心血管磁共振数据（LA 容积、LA 排空分数[LA-EF]和右心房排空分数[RA-EF]）测量。
结果
研究人群包括 211 例患者（65 ± 11 岁；124 例[59%]为男性；122 例[58%]为持续性 AF；54 例[26%]为 LVA）。根据 AF 进展表型，存在 4 个疾病进展组：无 LVA 的阵发性 AF、有 LVA 的阵发性 AF、无 LVA 的持续性 AF 和有 LVA 的持续性 AF。尽管 LA 容积随着 AF 进展表型而增加（分别为 98 ± 27、145 ± 34、134 ± 41 和 141 ± 39 mL；P <.001），但总 LA-EF（51% ± 17%、32% ± 17%、33% ± 17%和 22% ± 11%；P <.001）和 RA-EF（47% ± 13%、36% ± 17%、30% ± 16%和 23% ± 12%；P <.001）均降低。多变量分析显示，年龄（比值比[OR] 1.084；95%置信区间[CI] 1.028-1.142；P =.003）、持续性 AF（OR 3.478；95% CI 1.117-10.830；P =.031）和总 LA-EF（OR 0.933；95% CI 0.899-0.968；P <.001）与 LVA 显著相关。使用受试者工作特征曲线分析，LA-EF（曲线下面积 0.778；95% CI 0.711-0.846；P <.001）和 RA-EF（曲线下面积 0.726；95% CI 0.650-0.802；P <.001）与无 LVA 显著相关。
结论
LVA 和持续性 AF 与总心房排空分数降低有关。
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