心脏结节病中心律失常的发生率及预测因素：一项多模态影像学研究。
Incidence and Predictors of Atrial Fibrillation in Cardiac Sarcoidosis: A Multimodality Imaging Study.
机构信息
Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Clinical Physiology and Nuclear Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
出版信息
JACC Cardiovasc Imaging. 2022 Sep;15(9):1622-1631. doi: 10.1016/j.jcmg.2022.02.025. Epub 2022 May 11.
BACKGROUND
In cardiac sarcoidosis (CS), the risk and predictors of new-onset atrial fibrillation (AF) are poorly known.
OBJECTIVES
The authors evaluated the incidence and characteristics of AF in newly diagnosed CS.
METHODS
The authors studied 118 patients (78 women, mean age 50 years) with AF-naive CS having undergone cardiac F-fluorodexoyglucose positron emission tomography (F-FDG PET) at the time of diagnosis. Details of patient characteristics and medical or device therapy were collected from hospital charts. The PET scans were re-analyzed for presence of atrial and ventricular inflammation, and coincident cardiac magnetic resonance (CMR) studies and single-photon emission computed tomography (SPECT) perfusions were analyzed for cardiac structure and function, including the presence and extent of myocardial scarring. Detection of AF was based on interrogation of intracardiac devices and on ambulatory or 12-lead electrocardiograms.
RESULTS
Altogether 34 patients (29%) suffered paroxysms of AF during follow-up (median, 3 years) with persistent AF developing in 7 patients and permanent AF in 4. The estimated 5-year incidence of AF was 55% (95% CI: 34%-72%) in the 39 patients with atrial F-FDG uptake at the time of diagnosis vs 18% (95% CI: 10%-28%) in the 79 patients without atrial uptake (P < 0.001). In cause-specific Cox regression analysis, atrial uptake was an independent predictor of AF (P < 0.001) with HR of 6.01 (95% CI: 2.64-13.66). Other independent predictors were an increased left atrial maximum volume (P < 0.01) and history of sleep apnea (P < 0.01). Ventricular involvement by PET, SPECT, or CMR was nonpredictive. Symptoms of AF prompted electrical cardioversion in 12 patients (35%). Three of the 34 patients (9%) experiencing AF suffered a stroke versus none of those remaining free of AF.
CONCLUSIONS
In newly diagnosed CS, future AF is relatively common and associated with atrial inflammation and enlargement on multimodality cardiac imaging.
背景
在心脏结节病（CS）中，新发心房颤动（AF）的风险和预测因素知之甚少。
目的
作者评估了新诊断的 CS 中 AF 的发生率和特征。
方法
作者研究了 118 例 AF 初发 CS 患者（78 例女性，平均年龄 50 岁），这些患者在诊断时均接受了心脏 F-氟脱氧葡萄糖正电子发射断层扫描（F-FDG PET）检查。从病历中收集了患者特征和药物或器械治疗的详细信息。对 PET 扫描进行了重新分析，以评估心房和心室炎症的存在情况，并对同期的心脏磁共振（CMR）研究和单光子发射计算机断层扫描（SPECT）灌注进行了分析，以评估心脏结构和功能，包括心肌瘢痕的存在和范围。AF 的检测基于对心内设备的询问以及动态或 12 导联心电图。
结果
共有 34 例患者（29%）在随访期间（中位时间 3 年）发生阵发性 AF，其中 7 例患者持续性 AF 进展，4 例患者永久性 AF 进展。在诊断时存在心房 F-FDG 摄取的 39 例患者中，预计 5 年 AF 发生率为 55%（95%CI：34%-72%），而在 79 例无心房摄取的患者中为 18%（95%CI：10%-28%）（P<0.001）。在基于病因的 Cox 回归分析中，心房摄取是 AF 的独立预测因子（P<0.001），HR 为 6.01（95%CI：2.64-13.66）。其他独立的预测因子包括左心房最大容积增加（P<0.01）和睡眠呼吸暂停史（P<0.01）。PET、SPECT 或 CMR 显示的心室受累无预测价值。AF 症状促使 12 例患者（35%）进行电复律。在发生 AF 的 34 例患者中，有 3 例（9%）发生卒中，而无 AF 的患者中无一例发生卒中。
结论
在新诊断的 CS 中，未来发生 AF 较为常见，与多模态心脏成像上的心房炎症和扩大有关。
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