Reyes Jorge L, Decker Joseph J, Parikh Romil, Zhang Michael, Eaton Anne, Inciardi Riccardo M, Ndumele Chiadi, Van't Hof Jeremy, Alonso Alvaro, Shah Amil M, Solomon Scott D, Chen Lin Yee
Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis.
Department of Epidemiology and Community Health, University of Minnesota, Minneapolis.
Mayo Clin Proc Innov Qual Outcomes. 2025 Apr 28;9(3):100611. doi: 10.1016/j.mayocpiqo.2025.100611. eCollection 2025 Jun.
To evaluate the association of longitudinal change in waist circumference (WC), waist-to-hip ratio (WHR), and body mass index (BMI) with left atrial (LA) function in the Atherosclerosis Risk in Communities study, a community-based cohort study.
We included 4008 participants (mean age, 75.1 years; 59% female; 20% Black) with 2D speckle-tracking echocardiographic LA strain data and without prevalent heart failure or atrial fibrillation at visit (V)5. Measures of adiposity were obtained at V4 (1996-1998) and V5 (2011-2013). We categorized change in WC, BMI, or WHR from V4 to V5 as consistently low (reference group), consistently elevated, increasing, and decreasing. Multivariable linear regression was used to evaluate the association of change in adiposity with LA function.
Participants with consistently elevated WC from V4 to V5 had the lowest mean LA reservoir (32.4%) and conduit function (14.4%). Compared with consistently low WC, increasing WC and consistently elevated WC were significantly associated with worse LA reservoir function (, -0.90; 95% CI, -1.61 to -0.18, and , -1.00; 95% CI, -1.56 to -0.44, respectively) and conduit function (, -0.66; 95% CI, -1.22 to -0.10, and , -1.02; 95% CI, -1.46 to -0.58, respectively), after adjusting for cardiovascular disease risk factors, physical activity, LV size and function, and LA size. Similarly, compared with consistently low WHR, consistently elevated WHR was significantly associated with worse LA reservoir (, -1.00; 95% CI, -1.61 to -0.39) and conduit functions (, -1.16; 95% CI, -1.64, -0.69). Compared with consistently low BMI, consistently elevated BMI was associated with significantly lower LA reservoir function (, -0.66; 95% CI, -1.20 to -0.12). Change in WC, WHR, and BMI were not associated with LA contractile function.
Worsening central adiposity from mid-life to late life is associated with reduced LA reservoir and conduit function, independent of LA size and LV size and function. This finding underscores the key role that consistently low adiposity might play in preventing atrial myopathy.
在社区队列研究“社区动脉粥样硬化风险研究”中，评估腰围（WC）、腰臀比（WHR）和体重指数（BMI）的纵向变化与左心房（LA）功能之间的关联。
我们纳入了4008名参与者（平均年龄75.1岁；59%为女性；20%为黑人），这些参与者在第5次随访时拥有二维斑点追踪超声心动图LA应变数据，且无心力衰竭或心房颤动病史。在第4次随访（1996 - 1998年）和第5次随访（2011 - 2013年）时获取肥胖指标。我们将从第4次随访到第5次随访时WC、BMI或WHR的变化分为持续低水平（参照组）、持续升高、升高和降低。采用多变量线性回归来评估肥胖变化与LA功能之间的关联。
从第4次随访到第5次随访WC持续升高的参与者，其LA储备功能（32.4%）和管道功能（14.4%）的平均水平最低。与WC持续低水平相比，WC升高和WC持续升高与更差的LA储备功能（β值分别为 -0.90；95%可信区间为 -1.61至 -0.18，以及β值为 -1.00；95%可信区间为 -1.56至 -0.44）和管道功能（β值分别为 -0.66；95%可信区间为 -1.22至 -0.10，以及β值为 -1.02；95%可信区间为 -1.46至 -0.58）显著相关，这是在调整了心血管疾病危险因素、身体活动、左心室大小和功能以及LA大小之后得出的结果。同样，与WHR持续低水平相比，WHR持续升高与更差的LA储备功能（β值为 -1.00；95%可信区间为 -1.61至 -0.39）和管道功能（β值为 -1.16；95%可信区间为 -1.64， -0.69）显著相关。与BMI持续低水平相比，BMI持续升高与显著更低的LA储备功能（β值为 -0.66；95%可信区间为 -1.20至 -0.12）相关。WC、WHR和BMI的变化与LA收缩功能无关。
从中年到老年中心性肥胖的加重与LA储备和管道功能降低相关，独立于LA大小以及左心室大小和功能。这一发现强调了持续低肥胖水平在预防心房肌病中可能发挥的关键作用。
