Department of Cardiology and Internal Diseases, Military Institute of Medicine, 01-755 Warsaw, Poland.
"Club 30", Polish Cardiac Society, 40-001 Katowice, Poland.
Nutrients. 2022 Sep 4;14(17):3652. doi: 10.3390/nu14173652.
An increased body mass index (BMI) is associated with a higher incidence of atrial fibrillation (AF) and a higher risk of thromboembolic complications in AF patients. The aim of this study was to investigate the effect of BMI on the risk of left atrial thrombi (LATs) in patients with nonvalvular AF/atrial flutter (AFl) (NV AF/AFl). Patients diagnosed with NVAF/AFl (between November 2018 and May 2020) were selected from the multicenter, prospective, observational Left Atrial Thrombus on Transesophageal Echocardiography (LATTEE) registry that included AF/AFl patients referred for cardioversion or ablation followed by transesophageal echocardiography. A total of 2816 AF/AFl patients (63.6% males; mean age 65.8 years; mean BMI 29.8 kg/m2) were included in the study. Two hundred and twenty-two of them (7.9%) had LATs. Compared with normal-weight patients, those with BMIs ≥ 25 kg/m2 more frequently presented clinical factors potentially provoking LATs, such as non-paroxysmal AF/AFl (p = 0.04), hypertension (p < 0.001), and diabetes (p < 0.001); had higher CHA2DS2 scores (p < 0.001); and had larger LA dimensions (LA diameter and LA area) (p < 0.001 for both parameters). On the other hand, they showed some features negatively related to thromboembolic risk; for example, they were younger (p < 0.001) and were more often male (p = 0.002). In addition, patients with abnormal BMIs were more likely to be smokers (p = 0.006) and to be treated with oral anticoagulants (p = 0.005). Despite these differences in the prevalence of thromboembolic risk factors, the incidence of LATs was not increased in patients with abnormal body weight (overweight and obese compared to normal-weight patients) in this large real-life cohort of AF/AFl patients. This is probably due to the balanced composition regarding the prevalence of positive and negative thromboembolic risk factors.
体重指数（BMI）升高与心房颤动（AF）发生率增加以及 AF 患者血栓栓塞并发症风险升高相关。本研究旨在探讨 BMI 对非瓣膜性 AF/心房扑动（AFl）（NV AF/AFl）患者左心房血栓（LAT）风险的影响。该研究从多中心、前瞻性、观察性左心房血栓经食管超声心动图（LATTEE）登记处中选取了诊断为 NVAF/AFl（2018 年 11 月至 2020 年 5 月）的患者，这些患者被转诊进行电复律或消融，随后进行经食管超声心动图检查。共纳入 2816 例 AF/AFl 患者（63.6%为男性；平均年龄 65.8 岁；平均 BMI 29.8kg/m2）。其中 222 例（7.9%）存在 LAT。与正常体重患者相比，BMI≥25kg/m2 的患者更常出现可能导致 LAT 的临床因素，如非阵发性 AF/AFl（p=0.04）、高血压（p<0.001）和糖尿病（p<0.001）；CHA2DS2 评分更高（p<0.001）；左心房尺寸（左房直径和左房面积）更大（p<0.001）。另一方面，他们存在一些与血栓栓塞风险负相关的特征；例如，他们更年轻（p<0.001），且更常为男性（p=0.002）。此外，BMI 异常的患者更可能为吸烟者（p=0.006），并接受口服抗凝剂治疗（p=0.005）。尽管 AF/AFl 患者的血栓栓塞危险因素流行率存在这些差异，但在该大型真实世界 AF/AFl 患者队列中，异常体重（超重和肥胖与正常体重患者相比）患者的 LAT 发生率并未增加。这可能是由于阳性和阴性血栓栓塞危险因素的流行率均衡所致。
