Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
JACC Clin Electrophysiol. 2023 Nov;9(11):2240-2249. doi: 10.1016/j.jacep.2023.07.012. Epub 2023 Sep 6.
Atrial myopathy refers to structural and functional cardiac abnormalities associated with atrial fibrillation and stroke, but appropriate diagnostic criteria are lacking.
This study aimed to assess prevalence, clinical correlates, and overlap between potential atrial myopathy markers.
The population-based SCAPIS (Swedish CArdioPulmonary bioImage Study) prospectively included 6,013 subjects without atrial fibrillation with 24-hour electrocardiograms. Resting electrocardiograms measuring P-wave indices were collected at 1 screening site (n = 1,201), and a random sample (n = 385) had echocardiographic left atrial volume index (LAVi). Atrial myopathy markers were defined as ≥500 premature atrial complexes/24 h, LAVi ≥34 mL/m, P-wave duration >120 milliseconds, or P-wave terminal force in V >4,000 ms·s. Clinical correlates included age, sex, body mass index, height, smoking, physical activity, coronary artery disease, diabetes, systolic blood pressure, antihypertensive medication, and low education.
Atrial myopathy was common; 42% of the sample with all diagnostic modalities available had ≥1 atrial myopathy marker, but only 9% had 2 and 0.3% had ≥3. Only P-wave duration and LAVi were correlated (ρ = 0.10; P = 0.04). Clinical correlates of premature atrial complexes, P-wave indices, and LAVi differed; current smoking (34% increase; P < 0.001), systolic blood pressure (4%/mm Hg increase; P = 0.01), diabetes (35% increase; P = 0.001), and coronary artery disease (71% increase; P = 0.003) were associated with premature atrial complexes, physical activity ≥2 h/wk was associated with increased LAVi (β-coefficient = 3.1; P < 0.0001) and body mass index was associated with P-wave duration (β-coefficient = 0.4/kg/m; P < 0.0001).
In the general population, indirect markers of atrial myopathy are common but only weakly correlated, and their risk factor patterns are different. More studies are needed to accurately identify individuals with atrial myopathy with diagnostic methods.
心房肌病是指与心房颤动和中风相关的结构性和功能性心脏异常，但缺乏适当的诊断标准。
本研究旨在评估潜在心房肌病标志物的患病率、临床相关性和重叠。
基于人群的 SCAPIS（瑞典心肺生物影像研究）前瞻性纳入了 6013 名无房颤且 24 小时心电图正常的受试者。在 1 个筛查点（n=1201）收集静息心电图测量 P 波指数，随机样本（n=385）进行超声心动图左心房容积指数（LAVi）测量。心房肌病标志物定义为≥500 个房性期前收缩/24 小时、LAVi≥34mL/m、P 波时限>120 毫秒或 P 波终末电势在 V 导联中>4000ms·s。临床相关性包括年龄、性别、体重指数、身高、吸烟、体力活动、冠心病、糖尿病、收缩压、降压药物和受教育程度低。
心房肌病较为常见；在有所有诊断方法的样本中，42%存在≥1 种心房肌病标志物，但仅有 9%存在 2 种，0.3%存在≥3 种。只有 P 波时限和 LAVi 呈相关性（ρ=0.10；P=0.04）。房性期前收缩、P 波指数和 LAVi 的临床相关性不同；当前吸烟（增加 34%；P<0.001）、收缩压（增加 4mmHg/mmHg；P=0.01）、糖尿病（增加 35%；P=0.001）和冠心病（增加 71%；P=0.003）与房性期前收缩相关，每周体力活动≥2 小时与 LAVi 增加相关（β系数=3.1；P<0.0001），体重指数与 P 波时限相关（β系数=0.4kg/m；P<0.0001）。
在普通人群中，心房肌病的间接标志物较为常见，但相关性较弱，其危险因素模式也不同。需要更多的研究来准确识别具有诊断方法的心房肌病个体。
