严重肥胖患者心脏手术后的术后心房颤动：腰围的附加价值

Postoperative atrial fibrillation following cardiac surgery in severe obesity: the added value of waist circumference.

作者信息

Roberge Jeanne, Paquin Amélie, Poirier Paul, O'Connor Sarah, Voisine Pierre, Després Jean-Pierre, Piché Marie-Eve

机构信息

Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada.

Department of Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.

出版信息

Int J Obes (Lond). 2025 May;49(5):827-834. doi: 10.1038/s41366-024-01707-z. Epub 2024 Dec 28.

DOI:10.1038/s41366-024-01707-z

PMID:39732973

Abstract

INTRODUCTION

Obesity is an independent risk factor for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) surgery. POAF in patients with severe obesity (body mass index [BMI] ≥ 35 kg/m) is less studied. Whether waist circumference (WC) improves prediction of POAF independently of BMI among patients with severe obesity remains unknown.

AIM

To evaluate the risk of POAF, the role of WC in predicting POAF and postoperative complications after CABG surgery in severe obesity.

METHODS

Our cohort included 7995 patients undergoing CABG surgery (2006-19). POAF risk was compared across BMI and WC categories. In patients with severe obesity, the association of an increase in WC with POAF risk was assessed.

RESULTS

763 (9.5%) patients had a BMI ≥ 35 kg/m. In this group, BMI was 38.5 ± 3.6 kg/m and WC was 123.4 ± 10.8 cm. More patients with severe obesity developed POAF compared to patients with a normal BMI (37 vs. 29%, aRR: 1.52[95%CI 1.36-1.72], p < 0.01). Within each BMI category, the risk of POAF was higher per increasing tertile of WC (p < 0.05). Among patients with a BMI ≥ 35 kg/m, every 10 cm increment in WC was associated with an increased risk of POAF (aRR: 1.16[95%CI 1.08-1.24], p < 0.01). POAF in patients with severe obesity was associated with increased hospital length of stay.

CONCLUSIONS

Severe obesity increases the risk of POAF after CABG surgery. In this subgroup, elevated WC may provide additional prognostic value independently of BMI. Since POAF is associated with adverse long-term outcomes, abdominal obesity by measurement of WC should be assessed and targeted even in patient with severe obesity. Central Illustration Increasing waist circumference associated with increased atrial fibrillation risk post coronary artery bypass grafting. Bar graph of the unadjusted absolute risk and 95% confidence interval of postoperative atrial fibrillation for each tertile of waist circumference per body mass index category. Comparison of postoperative atrial fibrillation risk with chi-square test showing an increasing risk of postoperative atrial fibrillation related to increasing waist circumference within each body mass index category.

ABBREVIATIONS

BMI, body mass index; POAF, postoperative atrial fibrillation; WC, waist circumference.

摘要

引言

肥胖是冠状动脉旁路移植术（CABG）后发生术后房颤（POAF）的独立危险因素。对于严重肥胖（体重指数[BMI]≥35kg/m²）患者的POAF研究较少。在严重肥胖患者中，腰围（WC）能否独立于BMI改善对POAF的预测尚不清楚。

目的

评估严重肥胖患者CABG术后POAF的风险、WC在预测POAF及术后并发症中的作用。

方法

我们的队列包括7995例行CABG手术的患者（2006 - 2019年）。比较不同BMI和WC类别的POAF风险。在严重肥胖患者中，评估WC增加与POAF风险的关联。

结果

763例（9.5%）患者BMI≥35kg/m²。该组患者BMI为38.5±3.6kg/m²，WC为123.4±10.8cm。与BMI正常的患者相比，严重肥胖患者发生POAF的更多（37%对29%，调整后风险比[aRR]：1.52[95%置信区间（CI）1.36 - 1.72]，p<0.01）。在每个BMI类别中，WC每增加一个三分位数，POAF风险就越高（p<0.05）。在BMI≥35kg/m²的患者中，WC每增加10cm与POAF风险增加相关（aRR：1.16[95%CI 1.08 - 1.24]，p<0.01）。严重肥胖患者的POAF与住院时间延长相关。

结论

严重肥胖增加CABG术后POAF的风险。在这个亚组中，WC升高可能独立于BMI提供额外的预后价值。由于POAF与不良的长期结局相关，即使在严重肥胖患者中，也应通过测量WC评估并针对腹部肥胖进行处理。中心插图冠状动脉旁路移植术后腰围增加与房颤风险增加相关。按体重指数类别划分的腰围每个三分位数的术后房颤未调整绝对风险和95%置信区间的柱状图。用卡方检验比较术后房颤风险，显示每个体重指数类别中术后房颤风险随腰围增加而增加。