Chou Hongda, Chen Hongxia, Xie Juan, Xu Aiqing, Mu Guanyu, Han Fei, Tse Gary, Li Guangping, Liu Tong, Fu Huaying
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
School of Public Health, Tianjin Medical University, Tianjin, China.
Front Physiol. 2020 Dec 7;11:580624. doi: 10.3389/fphys.2020.580624. eCollection 2020.
The possible association between atrial fibrillation (AF) and left ventricular-to-right atrial shunt (LVRAS) has never been reported yet. The present study investigated the incidence of AF in LVRAS. This was a retrospective study of consecutive patients undergoing echocardiography at a single tertiary center. Clinical data, laboratory results and echocardiography parameters such as right atrial area (RAA), right ventricular end diastolic diameter (RVDD) and left atrial diameter (LAD) were compared between LVRAS group and non-LVRAS patients, and between AF and non-AF patients. Propensity score matching was performed to decrease the effect of confounders. Logistic regression analysis and mediation analysis were used to estimate the relationship between LVRAS and AF. A total of 3,436 patients were included, and the incidence of LVRAS was 1.16% ( = 40). The LVRAS group had significantly larger RAA, RVDD and LAD compared with non-LVRAS group. Those who suffered from AF showed larger RAA, RVDD and LAD compared with those who maintained sinus rhythm. Multivariable logistic regression showed that gender (OR: 0.608), age (OR: 1.048), LAD (OR: 1.111), mean pulmonary artery blood pressure (mPAP, OR: 1.023), TR (OR: 2.309) and LVRAS (OR: 12.217) were significant factors for AF. RAA could partially mediate the relationship between LVRAS and AF according to the result of mediation analysis. Our study suggested that LVRAS, TR, LAD, mPAP, age and male were risk factors for AF. RA enlargement might underlie mechanism in the higher incidence of AF in LVRAS patients. These findings should be confirmed in larger prospective studies.
心房颤动（AF）与左心室向右心房分流（LVRAS）之间可能存在的关联尚未见报道。本研究调查了LVRAS患者中AF的发生率。这是一项在单一三级中心对连续接受超声心动图检查的患者进行的回顾性研究。比较了LVRAS组与非LVRAS患者之间，以及AF患者与非AF患者之间的临床资料、实验室检查结果和超声心动图参数，如右心房面积（RAA）、右心室舒张末期内径（RVDD）和左心房直径（LAD）。进行倾向得分匹配以减少混杂因素的影响。采用逻辑回归分析和中介分析来评估LVRAS与AF之间的关系。共纳入3436例患者，LVRAS的发生率为1.16%（n = 40）。与非LVRAS组相比，LVRAS组的RAA、RVDD和LAD明显更大。与维持窦性心律的患者相比，AF患者的RAA、RVDD和LAD更大。多变量逻辑回归显示，性别（OR：0.608）、年龄（OR：1.048）、LAD（OR：1.111）、平均肺动脉压（mPAP，OR：1.023）、三尖瓣反流（TR，OR：2.309）和LVRAS（OR：12.217）是AF的显著相关因素。根据中介分析结果，RAA可能部分介导LVRAS与AF之间的关系。我们的研究表明，LVRAS、TR、LAD、mPAP、年龄和男性是AF的危险因素。右心房扩大可能是LVRAS患者AF发生率较高的潜在机制。这些发现应在更大规模的前瞻性研究中得到证实。
