Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Nutr Metab Cardiovasc Dis. 2021 Nov 29;31(12):3426-3433. doi: 10.1016/j.numecd.2021.08.044. Epub 2021 Sep 7.
Obesity increases the risk for atrial fibrillation (AF), although the impact of abdominal fat distribution on left atrial (LA) morphology and functional remodeling remains unclear. This study aimed to investigate whether increased abdominal adiposity is independently associated with impaired LA function and/or LA enlargement in a sample of the general population and to evaluate the role of adipokines in this association.
The study cohort consisted of 527 participants (362 men; 57 ± 10 years) without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination and echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess LA phasic function including reservoir, conduit and pump strain. LA reservoir and conduit strain decreased with increasing VFA quartiles (both p < 0.05), whereas no significant differences were observed in LA volume index and pump strain. When stratified by SFA, there were no significant differences in LA size and function across the quartiles. In multivariable analysis, VFA was significantly associated with LA conduit strain independent of cardiovascular risk factors, and pertinent laboratory and echocardiographic parameters (standardized β = -0.136, p = 0.019). VFA was correlated with serum adiponectin level (r = -0.51, p < 0.001), but there was no association between adiponectin level and three LA phasic strains.
In a sample of the general population, VFA accumulation was independently associated with worse LA conduit strain, which may be involved in the pathophysiological mechanism of obesity-related AF.
肥胖会增加心房颤动（AF）的风险，尽管腹部脂肪分布对左心房（LA）形态和功能重构的影响仍不清楚。本研究旨在探讨在一般人群样本中，腹部肥胖是否与 LA 功能障碍和/或 LA 增大独立相关，并评估脂肪因子在这种相关性中的作用。
该研究队列包括 527 名无明显心脏疾病的参与者（362 名男性；57±10 岁），他们接受了实验室检查、腹部计算机断层扫描检查和超声心动图检查。腹部肥胖通过脐水平的内脏脂肪面积（VFA）和皮下脂肪面积（SFA）进行定量评估。采用斑点追踪超声心动图评估 LA 时相功能，包括储备、传导和泵应变。LA 储备和传导应变随 VFA 四分位数的增加而降低（均 p<0.05），而 LA 容积指数和泵应变无显著差异。当按 SFA 分层时，LA 大小和功能在四分位数之间没有显著差异。在多变量分析中，VFA 与 LA 传导应变独立于心血管危险因素以及相关的实验室和超声心动图参数相关（标准化β=-0.136，p=0.019）。VFA 与血清脂联素水平呈负相关（r=-0.51，p<0.001），但脂联素水平与 LA 三个时相应变之间没有关联。
在一般人群样本中，VFA 堆积与 LA 传导应变较差独立相关，这可能涉及肥胖相关 AF 的病理生理机制。
