Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany.
Abteilung für Rhythmologie, Herzzentrum Leipzig, Leipzig, Germany.
PLoS One. 2022 Apr 22;17(4):e0266848. doi: 10.1371/journal.pone.0266848. eCollection 2022.
The contribution of left atrial disease and excessive supraventricular ectopic activity (ESVEA) to the risk for incident atrial fibrillation (AF) is incompletely understood.
To analyse the ten-year risk to develop AF in patients with cardiovascular risk factors and to define the impact of parameters of left atrial disease and ESVEA on AF risk.
148 patients from the Diast-CHF trial with at least one cardiovascular risk factor and free of AF at baseline were followed for 10 years. Left atrial disease was defined as left atrial volume index (LAVI) >35 ml/m2, P-terminal force in lead V1 (PTFV1) >4000 ms*μV or elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) >250 pg/ml. We analyzed the association of these parameters and ESVEA (either >720 premature atrial contractions (PAC) or one atrial run >20 beats per day) on AF-free survival.
After ten years, AF was newly detected in twelve patients (13.4%) with signs of left atrial disease and two patients (3.4%) without signs of left atrial disease (p = 0.04). LAVI (p = 0.005), ESVEA (p = 0.016) and NT-proBNP (p = 0.010) were significantly associated with AF-free survival in univariate analysis. A combined Cox model of left atrial disease parameters showed associations for NT-proBNP (HR 3.56; 95%CI 1.33-5.31; p = 0.04) and PAC (HR 2.66; 95%CI 1.25-10.15; p = 0.01) but not for LAVI or PTFV1 with AF-free survival.
The risk for AF is higher in patients with cardiovascular risk factors and signs of left atrial disease. NT-proBNP and premature atrial contractions independently predict AF-free survival. The role of excessive supraventricular ectopic activity for the assessment of AF risk may be underestimated and requires further study.
左心房疾病和过度室上性异位活动（ESVEA）对房颤（AF）发病风险的影响尚不完全清楚。
分析有心血管危险因素的患者十年内发生房颤的风险，并确定左心房疾病和 ESVEA 参数对房颤风险的影响。
Diast-CHF 试验中 148 例至少有一个心血管危险因素且基线时无房颤的患者，随访 10 年。左心房疾病定义为左心房容积指数（LAVI）>35ml/m2，V1 导联 P 波终末电势（PTFV1）>4000ms*μV 或升高的 N 末端 pro-B 型利钠肽（NT-proBNP）>250pg/ml。我们分析了这些参数与 ESVEA（>720 个房性期前收缩（PAC）或一日内一个房性心动过速>20 个）对无房颤生存的关系。
十年后，12 例（13.4%）有左心房疾病征象的患者和 2 例（3.4%）无左心房疾病征象的患者新检出房颤（p=0.04）。在单因素分析中，LAVI（p=0.005）、ESVEA（p=0.016）和 NT-proBNP（p=0.010）与无房颤生存显著相关。左心房疾病参数的联合 Cox 模型显示，NT-proBNP（HR 3.56；95%CI 1.33-5.31；p=0.04）和 PAC（HR 2.66；95%CI 1.25-10.15；p=0.01）与房颤生存相关，但 LAVI 或 PTFV1 与房颤生存无关。
有心血管危险因素和左心房疾病征象的患者发生房颤的风险更高。NT-proBNP 和房性期前收缩独立预测房颤生存。过度室上性异位活动对房颤风险评估的作用可能被低估，需要进一步研究。
