Chin J F, Aga Y S, Abou Kamar S, Snelder S M, Kardys I, de Boer R A, Brugts J J, van Dalen B M
Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
Int J Cardiol Heart Vasc. 2024 Nov 14;55:101555. doi: 10.1016/j.ijcha.2024.101555. eCollection 2024 Dec.
Although obesity is a major risk factor for atrial fibrillation (AF), its mechanisms and the diagnostic yield of AF screening in severe obesity is unclear. This study aims to enhance our comprehension of AF susceptibility in severe obesity by investigating associations between left atrial (LA) cardiomyopathy and premature atrial contractions (PACs) and to explore the diagnostic yield of AF screening.
This cross-sectional study included a total of 192 subjects aged 35-65 years with a BMI ≥ 35 kg/m, alongside 50 non-obese controls, both without known cardiac disease. Prolonged heart rhythm registration was done with either 24-hours (n = 147) or 7-day Holter monitoring (n = 75) or an implantable loop recorder (ILR) (n = 10). Furthermore, we performed conventional transthoracic echocardiography and strain analyses.
In the obese cohort, LA enlargement was independently associated with PAC frequency. Each SD increment (10 ml/m) of LA volume index corresponded with a 46 % increase in PACs. An increase of each SD (10 %) LA reservoir strain was associated with a decrease of 16 % in PAC frequency. There was no association found between LA cardiomyopathy and PACs in the control group. AF was not detected in any subject.
LA enlargement was independently associated with more frequent PACs in severe obesity, a well-known AF precursor. There was a noticeable trend suggesting a relation between impaired LA function and PACs. Considering our observed low diagnostic yield of AF screening within this population, further investigation is needed to determine whether incorporating LA cardiomyopathy as an additional risk measure could improve AF screening strategies for individuals with severe obesity.
尽管肥胖是心房颤动（AF）的主要危险因素，但其机制以及严重肥胖人群中AF筛查的诊断率尚不清楚。本研究旨在通过调查左心房（LA）心肌病与房性早搏（PACs）之间的关联，提高我们对严重肥胖人群中AF易感性的理解，并探索AF筛查的诊断率。
这项横断面研究共纳入了192名年龄在35 - 65岁、BMI≥35 kg/m²的受试者，以及50名无已知心脏病的非肥胖对照者。采用24小时（n = 147）或7天动态心电图监测（n = 75）或植入式循环记录仪（ILR）（n = 10）进行长时间心律记录。此外，我们还进行了传统的经胸超声心动图检查和应变分析。
在肥胖队列中，LA扩大与PAC频率独立相关。LA容积指数每增加1个标准差（10 ml/m²），PACs增加46%。LA储备应变每增加1个标准差（10%），PAC频率降低16%。对照组中未发现LA心肌病与PACs之间存在关联。所有受试者均未检测到AF。
在严重肥胖（一种众所周知的AF前驱因素）中，LA扩大与更频繁的PACs独立相关。有明显趋势表明LA功能受损与PACs之间存在关联。鉴于我们在该人群中观察到的AF筛查诊断率较低，需要进一步研究以确定将LA心肌病作为额外的风险指标是否可以改善严重肥胖个体的AF筛查策略。
