Mulder Mark J, Kemme Michiel J B, Visser Charlotte L, Hopman Luuk H G A, van Diemen Pepijn A, van de Ven Peter M, Götte Marco J W, Danad Ibrahim, Knaapen Paul, van Rossum Albert C, Allaart Cornelis P
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Int J Cardiol. 2020 Apr 1;304:69-74. doi: 10.1016/j.ijcard.2020.01.042. Epub 2020 Jan 22.
Left atrial (LA) sphericity has been proposed as a more sensitive marker of atrial fibrillation (AF)-associated atrial remodeling compared to traditional markers such as LA size. However, mechanisms that underlie changes in LA sphericity are not fully understood and studies investigating the predictive value of LA sphericity for AF ablation outcome have yielded conflicting results. The present study aimed to assess correlates of LA sphericity and to compare LA sphericity in subjects with and without AF.
Measures of LA size (LA diameter, LA volume, LA volume index), LA sphericity and thoracic anteroposterior diameter (APd) at the level of the LA were determined using computed tomography (CT) imaging data in 293 AF patients (62% paroxysmal AF) and 110 controls.
LA diameter (40.1 ± 6.8 mm vs. 35.2 ± 5.1 mm; p < 0.001), LA volume (116.0 ± 33.0 ml vs. 80.3 ± 22.6 ml; p < 0.001) and LA volume index (56.1 ± 15.3 ml/m vs. 41.6 ± 11.1 ml/m; p < 0.001) were significantly larger in AF patients compared to controls, also after adjustment for covariates. LA sphericity did not differ between AF patients and controls (83.7 ± 2.9 vs. 83.9 ± 2.4; p = 0.642). Multivariable linear regression analysis demonstrated that LA diameter, LA volume, female sex, body length and thoracic APd were independently associated with LA sphericity.
The present study suggests that thoracic constraints rather than the presence of AF determine LA sphericity, implying LA sphericity to be unsuitable as a marker of AF-related atrial remodeling.
与左心房（LA）大小等传统指标相比，左心房球形度被认为是心房颤动（AF）相关心房重构更敏感的标志物。然而，左心房球形度变化的潜在机制尚未完全明确，且关于左心房球形度对AF消融结果预测价值的研究结果相互矛盾。本研究旨在评估左心房球形度的相关因素，并比较有AF和无AF受试者的左心房球形度。
利用计算机断层扫描（CT）成像数据，测定了293例AF患者（62%为阵发性AF）和110例对照者的左心房大小（左心房直径、左心房容积、左心房容积指数）、左心房球形度以及左心房水平的胸廓前后径（APd）。
AF患者的左心房直径（40.1±6.8mm对35.2±5.1mm；p<0.001）、左心房容积（116.0±33.0ml对80.3±22.6ml；p<0.001）和左心房容积指数（56.1±15.3ml/m对41.6±11.1ml/m；p<0.001）均显著大于对照者，在调整协变量后也是如此。AF患者与对照者的左心房球形度无差异（83.7±2.9对83.9±2.4；p=0.642）。多变量线性回归分析表明，左心房直径、左心房容积、女性性别、身高和胸廓APd与左心房球形度独立相关。
本研究提示，胸廓限制而非AF的存在决定左心房球形度，这意味着左心房球形度不适宜作为AF相关心房重构的标志物。
