Yoshimoto Issei, Ichiki Hitoshi, Miyata Masaaki, Kamada Hiroyuki, Ninomiya Yuichi, Yoshimura Akino, Iriki Yasuhisa, Okui Hideki, Oketani Naoya, Tajima Akari, Uchiyama Youta, Hamamoto Yuki, Horizoe Yoshihisa, Maenosono Ryuichi, Ikeda Yoshiyuki, Ohishi Mitsuru
Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University.
Division of Clinical Laboratory, Kagoshima University Hospital.
Int Heart J. 2023;64(4):623-631. doi: 10.1536/ihj.23-072.
Arterial stiffness has been reported to cause left atrial (LA) remodeling due to increased left ventricular filling pressure, resulting in atrial fibrillation (AF). This study aimed to evaluate the association between LA reverse remodeling (LARR) after AF ablation and cardio-ankle vascular index (CAVI), an indicator of arterial stiffness.This study included 333 patients with AF (171 with paroxysmal AF and 162 with nonparoxysmal AF) and LA enlargement (LA volume index ≥ 34 mL/m) who underwent AF ablation between December 2008 and July 2021. CAVI was evaluated preoperatively during AF (n = 155, 46.5%) or sinus rhythm (n = 178, 53.5%). Participants were divided into groups with LARR (n = 133, 39.9%) and without LARR (n = 200, 60.1%) according to whether the degree of decrease in LA volume index on transthoracic echocardiography 6 months after ablation was ≥ 15% or < 15%, respectively.Sinus rhythm was maintained in 168 (50.5%) patients within 3-6 months after the index procedure. Univariate analysis revealed that preoperative CAVI (7.80 ± 1.22 versus 8.57 ± 1.09, P < 0.001) was significantly lower, and the maintenance of sinus rhythm (61.6% versus 43.0%, P = 0.0011) was higher in the group with LARR. Multivariate logistic regression analysis revealed that preoperative CAVI was independently associated with LARR (odds ratio, 0.60, 95% confidence interval, 0.46-0.78, P < 0.001).In patients with AF and LA enlargement, CAVI is independently associated with LA reverse remodeling after catheter ablation.
据报道，由于左心室充盈压升高，动脉僵硬度会导致左心房（LA）重塑，进而引发心房颤动（AF）。本研究旨在评估房颤消融术后左心房逆向重塑（LARR）与动脉僵硬度指标——心踝血管指数（CAVI）之间的关联。本研究纳入了2008年12月至2021年7月期间接受房颤消融治疗的333例房颤患者（171例阵发性房颤患者和162例非阵发性房颤患者），且这些患者存在左心房扩大（左心房容积指数≥34 mL/m²）。术前在房颤期间（n = 155，46.5%）或窦性心律期间（n = 178，53.5%）评估CAVI。根据消融术后6个月经胸超声心动图检查左心房容积指数的下降程度是否≥15%或<15%，将参与者分为有LARR组（n = 133，39.9%）和无LARR组（n = 200，60.1%）。在首次手术后3至6个月内，168例（50.5%）患者维持窦性心律。单因素分析显示，有LARR组的术前CAVI显著更低（7.80±1.22 vs 8.57±1.09，P<0.001），且窦性心律维持率更高（61.6% vs 43.0%，P = 0.0011）。多因素逻辑回归分析显示，术前CAVI与LARR独立相关（比值比，0.60；95%置信区间，0.46 - 0.78；P<0.001）。在房颤合并左心房扩大的患者中，CAVI与导管消融术后左心房逆向重塑独立相关。
