右心房结构与房颤发生的关联：来自动脉粥样硬化多族裔研究（MESA）的一项纵向队列心血管磁共振研究
Association of right atrial structure with incident atrial fibrillation: a longitudinal cohort cardiovascular magnetic resonance study from the Multi-Ethnic Study of Atherosclerosis (MESA).
作者信息
Xie Eric, Yu Ricky, Ambale-Venkatesh Bharath, Bakhshi Hooman, Heckbert Susan R, Soliman Elsayed Z, Bluemke David A, Kawut Steven M, Wu Colin O, Nazarian Saman, Lima João A C
机构信息
Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Blalock 524D, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
Heart Service, Department of Medicine, UCLA School of Medicine, Los Angeles, CA, USA.
出版信息
J Cardiovasc Magn Reson. 2020 May 21;22(1):36. doi: 10.1186/s12968-020-00631-1.
BACKGROUND
While studies of the left atrium (LA) have demonstrated associations between volumes and emptying fraction with atrial fibrillation (AF), the contribution of right atrial (RA) abnormalities to incident AF remains poorly understood.
OBJECTIVES
Assess the association between RA structure and function with incident AF using feature-tracking cardiovascular magnetic resonance (CMR).
METHODS
This is a prospective cohort study of all participants in the Multi-Ethnic Study of Atherosclerosis with baseline CMR, sinus rhythm, and free of clinical cardiovascular disease at study initiation. RA volume, strain, and emptying fraction in participants with incident AF (n = 368) were compared against AF-free (n = 2779). Cox proportional-hazards models assessed association between variables.
RESULTS
Participants were aged 60 ± 10 yrs., 55% female, and followed an average 11.2 years. Individuals developing AF had higher baseline RA maximum volume index (mean ± standard deviation [SD]: 24 ± 9 vs 22 ± 8 mL/m, p = 0.002) and minimum volume index (13 ± 7 vs 12 ± 6 mL/m, p < 0.001), and lower baseline RA emptying fraction (45 ± 15% vs 47 ± 15%, p = 0.02), peak global strain (34 ± 17% vs 36 ± 19%, p < 0.001), and peak free-wall strain (40 ± 23% vs 42 ± 26%, p = 0.049) compared with the AF-free population. After adjusting for traditional cardiovascular risk factors and LA volume and function, we found RA maximum volume index (hazards ratio [HR]: 1.13 per SD, p = 0.041) and minimum volume index (HR: 1.12 per SD, p = 0.037) were independently associated with incident AF.
CONCLUSIONS
In a large multiethnic population, higher RA volume indices were independently associated with incident AF after adjustment for conventional cardiovascular risk factors and LA parameters. It is unclear if this predictive value persists when additional adjustment is made for ventricular parameters.
背景
虽然对左心房（LA）的研究已证明心房容积和排空分数与心房颤动（AF）之间存在关联，但右心房（RA）异常对新发房颤的影响仍知之甚少。
目的
使用特征追踪心血管磁共振（CMR）评估RA结构和功能与新发房颤之间的关联。
方法
这是一项对动脉粥样硬化多民族研究中所有参与者的前瞻性队列研究，这些参与者在研究开始时具有基线CMR、窦性心律且无临床心血管疾病。将发生房颤的参与者（n = 368）的RA容积、应变和排空分数与未发生房颤的参与者（n = 2779）进行比较。Cox比例风险模型评估变量之间的关联。
结果
参与者年龄为60±10岁，55%为女性，平均随访11.2年。与未发生房颤的人群相比，发生房颤的个体基线RA最大容积指数（均值±标准差[SD]：24±9 vs 22±8 mL/m²，p = 0.002）和最小容积指数（13±7 vs 12±6 mL/m²，p < 0.001）更高，而基线RA排空分数（45±15% vs 47±15%，p = 0.02）、整体峰值应变（34±17% vs 36±19%，p < 0.001）和游离壁峰值应变（40±23% vs 42±26%，p = 0.049）更低。在调整传统心血管危险因素以及LA容积和功能后，我们发现RA最大容积指数（风险比[HR]：每标准差1.13，p = 0.041）和最小容积指数（HR：每标准差1.12，p = 0.037）与新发房颤独立相关。
结论
在一个大型多民族人群中，在调整传统心血管危险因素和LA参数后，较高的RA容积指数与新发房颤独立相关。当对心室参数进行额外调整时，这种预测价值是否仍然存在尚不清楚。
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