Shchetynska-Marinova T, Kranert M, Baumann S, Liebe V, Grafen A, Gerhards S, Rosenkaimer S, Akin I, Borggrefe M, Hohneck A L
First Department of Medicine-Cardiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
partner site Mannheim, German Centre for Cardiovascular Research (DZHK), Mannheim, Germany.
Neth Heart J. 2022 Apr;30(4):198-206. doi: 10.1007/s12471-021-01644-w. Epub 2021 Nov 24.
Arterial stiffness (AS) has emerged as a strong predictor of cardiovascular (CV) diseases. Although increased AS has been described as a predictor of atrial fibrillation (AF), its role as a risk marker for AF recurrence has not yet been elucidated.
Patients with AF who underwent pulmonary vein isolation (PVI) were included in this study. Presence of AS was evaluated by measuring aortic distensibility (AD) of the descending aorta by transoesophageal echocardiography.
In total, 151 patients (mean ± standard deviation (SD) age 71.9 ± 9.8 years) were enrolled and followed for a median duration of 21 months (interquartile range 15.0-31.0). During follow-up, AF recurred in 94 (62.3%) patients. AF recurrence was seen more frequently in patients with permanent AF (27% vs 46%, p = 0.03) and in those who had undergone prior PVI (9% vs 23%, p = 0.02). AD was significantly reduced in patients with AF recurrence (mean ± SD 2.6 ± 2.3 vs 1.5 ± 0.7 × 10 mm Hg, p < 0.0001), as well as left atrial volume index (LAVI) (mean ± SD 29 ± 12 vs 44 ± 15 ml/m, p < 0.0001). Multivariable analysis revealed LAVI (odds ratio (OR) 2.9, 95% confidence interval (CI) 1.2-3.4) and AS (OR 3.6, 95% CI 2.8-4.1) as independent risk factors of AF recurrence.
Increased AS and left atrial size were independent predictors of AF recurrence after PVI. AD as surrogate marker of AS seemed to reflect the overall CV risk. In addition, AD was significantly correlated with left atrial size, which suggests that increased AS leads to atrial remodelling and thus to AF recurrence.
German registry for clinical studies (DRKS), DRKS00019007.
动脉僵硬度（AS）已成为心血管（CV）疾病的有力预测指标。尽管AS增加已被描述为心房颤动（AF）的预测指标，但其作为AF复发风险标志物的作用尚未阐明。
本研究纳入了接受肺静脉隔离（PVI）的AF患者。通过经食管超声心动图测量降主动脉的主动脉扩张性（AD）来评估AS的存在情况。
总共纳入了151例患者（平均±标准差（SD）年龄71.9±9.8岁），中位随访时间为21个月（四分位间距15.0 - 31.0）。随访期间，94例（62.3%）患者发生AF复发。永久性AF患者（27%对46%，p = 0.03）和既往接受过PVI的患者（9%对23%，p = 0.02）中AF复发更常见。AF复发患者的AD显著降低（平均±SD 2.6±2.3对1.5±0.7×10 mmHg，p < 0.0001），左心房容积指数（LAVI）也是如此（平均±SD 29±12对44±15 ml/m，p < 0.0001）。多变量分析显示LAVI（比值比（OR）2.9，95%置信区间（CI）1.2 - 3.4）和AS（OR 3.6，95% CI 2.8 - 4.1）是AF复发的独立危险因素。
AS增加和左心房大小是PVI后AF复发的独立预测因素。AD作为AS的替代标志物似乎反映了总体CV风险。此外，AD与左心房大小显著相关，这表明AS增加导致心房重构，进而导致AF复发。
德国临床研究注册中心（DRKS），DRKS00019007。
