Shchetynska-Marinova Tetyana, Liebe Volker, Papavassiliu Theano, de Faria Fernandez Andréa, Hetjens Svetlana, Sieburg Tina, Doesch Christina, Sigl Martin, Akin Ibrahim, Borggrefe Martin, Hohneck Anna
First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany.
First department of medicine (cardiology), University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, European Centre for AngioScience (ECAS), 68167 Mannheim, Germany; DZHK (German centre for cardiovascular research) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany.
Arch Cardiovasc Dis. 2021 Aug-Sep;114(8-9):550-560. doi: 10.1016/j.acvd.2020.12.009. Epub 2021 Apr 23.
Arterial stiffness has emerged as a strong predictor of cardiovascular disease, end-organ damage and all-cause mortality. Although increased arterial stiffness has been described as a predictor of atrial fibrillation, the relationship between arterial stiffness and atrial fibrillation is uncertain.
We assessed arterial stiffness in patients with atrial fibrillation compared with that in a control group.
We enrolled 151 patients with atrial fibrillation who underwent pulmonary vein isolation (mean age 71.1±9.8 years) and 54 control patients with similar cardiovascular risk profiles and sinus rhythm, matched for age (mean age 68.6±15.7 years) and sex. Aortic distensibility as a measure of arterial stiffness was assessed by transoesophageal echocardiography. Patients with atrial fibrillation were followed over a median of 21 (15 to 31) months.
Compared with control patients, patients with atrial fibrillation had significantly lower aortic distensibility (1.8±1.1 vs. 2.1±1.1 10mmHg; P=0.02). Age (hazard ratio 0.67, 95% confidence interval 0.003 to 0.03; P=0.02) and pulse pressure (hazard ratio -1.35, 95% confidence interval -0.07 to -0.03; P<0.0001) were the strongest predictors of decreased aortic distensibility in the study cohort. This effect was independent of the type of atrial fibrillation (paroxysmal/persistent). During follow-up, decreased aortic distensibility was a predictor of cardiovascular and all-cause hospitalizations, as well as recurrences of atrial fibrillation, with a higher incidence rate of events in patients in the lowest aortic distensibility quartile (P=0.001).
Aortic distensibility was significantly reduced in patients with atrial fibrillation, with age and pulse pressure showing the strongest correlation, independent of the type of atrial fibrillation. Additionally, decreased aortic distensibility was associated with cardiovascular and all-cause hospitalizations, as well as recurrences of atrial fibrillation, which showed a quartile-dependent occurrence.
动脉僵硬度已成为心血管疾病、终末器官损害和全因死亡率的有力预测指标。尽管动脉僵硬度增加已被描述为心房颤动的一个预测指标，但动脉僵硬度与心房颤动之间的关系尚不确定。
我们评估了心房颤动患者与对照组患者的动脉僵硬度。
我们纳入了151例行肺静脉隔离术的心房颤动患者（平均年龄71.1±9.8岁）和54例具有相似心血管风险特征且为窦性心律的对照患者，这些对照患者在年龄（平均年龄68.6±15.7岁）和性别上进行了匹配。通过经食管超声心动图评估作为动脉僵硬度指标的主动脉扩张性。对心房颤动患者进行了中位数为21（15至31）个月的随访。
与对照患者相比，心房颤动患者的主动脉扩张性显著降低（1.8±1.1对2.1±1.1 10mmHg；P=0.02）。年龄（风险比0.67，95%置信区间0.003至0.03；P=0.02）和脉压（风险比-1.35，95%置信区间-0.07至-0.03；P<0.0001）是研究队列中主动脉扩张性降低的最强预测因素。这种效应独立于心房颤动的类型（阵发性/持续性）。在随访期间，主动脉扩张性降低是心血管和全因住院以及心房颤动复发的预测指标，在主动脉扩张性最低四分位数的患者中事件发生率更高（P=0.001）。
心房颤动患者的主动脉扩张性显著降低，年龄和脉压显示出最强的相关性，独立于心房颤动的类型。此外，主动脉扩张性降低与心血管和全因住院以及心房颤动复发相关，且复发呈现四分位数依赖性。
