Ma Pingchuan, Gao Zhicheng, Bao Jiaqi, Hu Yilan, Sun Pengfei, Yan Qiqi, Ye Lifang, Wang Lihong
The Second Clinical Medical College, Zhejiang Chinese Medical University, 310000 Hangzhou, Zhejiang, China.
Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), 310000 Hangzhou, Zhejiang, China.
Rev Cardiovasc Med. 2025 Apr 23;26(4):26933. doi: 10.31083/RCM26933. eCollection 2025 Apr.
This research focuses on the unresolved question of how low muscle mass influences the likelihood of atrial fibrillation (AF) recurrence after ablation treatment. Despite the growing body of evidence highlighting the importance of muscle mass in cardiovascular health, the specific impact of low muscle mass on the recurrence of AF following ablation has yet to be well-established. Thus, this study evaluated the relationship between a low computed tomography (CT)-based skeletal muscle index (SMI) of muscle sites at the fourth thoracic level (T4-SMI) and AF recurrence post-radiofrequency ablation. Furthermore, this study aimed to determine whether the T4-SMI is a predictive marker for AF recurrence.
This study included 641 patients with AF who underwent radiofrequency ablation. T4 muscle sites were determined using SliceOmatic software. Height- and body mass index (BMI)-corrected SMIs were calculated.
The lowest quartile in the T4-SMI group was defined for each sex as the "low SMI" group. The height-adjusted T4-SMI thresholds were 69.7 cm/m for males and 55.91 cm/m for females. The BMI-adjusted thresholds were 8.10 cm/kg/m for males and 5.78 cm/kg/m for females. After potential confounder adjustment, low T4-SMI was associated with a higher risk of AF recurrence. The correlation between T4-SMI (height) and AF recurrence was fully validated by constructing multiple models, and adjusting for different covariates barely altered the results. Fully adjusted models suggested that compared with the fourth T4-SMI (height) quartile, the risk odds ratio (OR) with a 95% confidence interval (CI) of the "low SMI" group was 1.57 (0.76-3.22). Finally, subgroup analysis and interaction according to gender, age, overweight/obesity, hypertension, or diabetes indicate that the differences between different layers are not significant.
Low CT-based BMI- or height-adjusted T4-SMIs were risk factors for AF recurrence post-radiofrequency ablation. A lower T4-SMI (height) significantly correlated with AF recurrence post-ablation, regardless of gender, age, or overweight/obesity. The height adjustment performed better than the BMI adjustment in that regard.
本研究聚焦于低肌肉量如何影响消融治疗后房颤（AF）复发这一尚未解决的问题。尽管越来越多的证据强调了肌肉量在心血管健康中的重要性，但低肌肉量对房颤消融术后复发的具体影响尚未得到充分证实。因此，本研究评估了基于计算机断层扫描（CT）的第四胸椎水平（T4）肌肉部位的骨骼肌指数（SMI）与射频消融术后房颤复发之间的关系。此外，本研究旨在确定T4-SMI是否为房颤复发的预测标志物。
本研究纳入了641例行射频消融术的房颤患者。使用SliceOmatic软件确定T4肌肉部位。计算身高和体重指数（BMI）校正后的SMI。
T4-SMI组中最低四分位数被定义为每个性别的“低SMI”组。身高校正后的T4-SMI阈值男性为69.7 cm/m，女性为55.91 cm/m。BMI校正后的阈值男性为8.10 cm/kg/m，女性为5.78 cm/kg/m。在对潜在混杂因素进行调整后，低T4-SMI与房颤复发风险较高相关。通过构建多个模型充分验证了T4-SMI（身高）与房颤复发之间的相关性，并且调整不同协变量几乎不改变结果。完全调整后的模型表明，与第四T4-SMI（身高）四分位数相比，“低SMI”组的风险优势比（OR）及95%置信区间（CI）为1.57（0.76 - 3.22）。最后，根据性别、年龄、超重/肥胖、高血压或糖尿病进行的亚组分析和交互分析表明，不同分层之间的差异不显著。
基于CT的BMI或身高校正后的低T4-SMI是射频消融术后房颤复发的危险因素。较低的T4-SMI（身高）与消融术后房颤复发显著相关，无论性别、年龄或超重/肥胖情况如何。在这方面，身高调整比BMI调整表现更好。
