Clinical impact of insulin resistance on pulmonary vein isolation outcome in patients with paroxysmal atrial fibrillation
Clinical impact of insulin resistance on pulmonary vein isolation outcome in patients with paroxysmal atrial fibrillation
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DOI：
10.1111/jce.13827
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发表时间：
2019-04-01
影响因子：
2.7
通讯作者：
Takeishi, Yasuchika
中科院分区：
文献类型：
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作者：
Hijioka, Naoko;Kamioka, Masashi;Takeishi, Yasuchika
胰岛素抵抗与肺静脉隔离（PVI）后房颤（AF）复发的关系尚不清楚。方法对114例经PVI治疗成功的难治性阵发性房颤患者（男性89例，年龄62±8岁）进行分析。计算胰岛素抵抗的稳态模型评估（HOMA-IR），定义>= 2.5为胰岛素抵抗。采用超声心动图测量左房容积指数（LAVI）。检测PVI前血清肿瘤坏死因子- α (tnf - α)和tgf - β 1水平，计算左心房传导速度。将患者分为两组（1组HOMA-IR < 2.5, n = 81； 2组HOMA-IR >= 2.5, n = 33）。结果PVI前两组LAVI无显著差异（P < 0.05）， tnf - α (7.7 +/- 2.0 vs 7.5 +/- 1.0 pg/mL, P = 0.149)和tgf - β 1 （28.4 +/- 12.0 vs 27.6 +/- 10.3 ng/mL, P = 0.757）无显著差异。各组患者术前及术后1年LAVI无明显变化。2组的传导速度较1组慢（0.7 +/- 0.1 vs 1.1 +/- 0.3 m/s, P < 0.001）。Kaplan-Meier分析显示，2组AF复发率明显高于1组（P = 0.019）。Cox多变量分析显示，胰岛素抵抗是复发的独立预测因子（风险比1.287,P = 0.004）。结论胰岛素抵抗促进左心室电重构，可能与PVI后房颤复发有关。
Introduction The relationship between insulin resistance and atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) remains unclear. Methods Drug-refractory 114 paroxysmal AF patients (89 males, 62 +/- 8 years) who underwent successful PVI were enrolled. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated and a value of >= 2.5 was defined as insulin resistant. The left atrial volume index (LAVI) was measured using echocardiography before and 1 year after PVI. Tumor necrosis factor-alpha (TNF-alpha) and TGF-beta 1 serum levels were measured before PVI, and the left atrium (LA) conduction velocity was calculated. The patients were divided into two groups (group 1: HOMA-IR < 2.5, n = 81; group 2: HOMA-IR >= 2.5, n = 33). Results The LAVI between the two groups before PVI did not significantly differ (P > 0.05), nor did TNF-alpha (7.7 +/- 2.0 vs 7.5 +/- 1.0 pg/mL; P = 0.149) or TGF-beta 1 (28.4 +/- 12.0 vs 27.6 +/- 10.3 ng/mL; P = 0.757). LAVI before and 1 year after PVI in each group did not change. The conduction velocity of group 2 was slower than that of group 1 (0.7 +/- 0.1 vs 1.1 +/- 0.3 m/s, P < 0.001). Kaplan-Meier analysis showed significantly higher AF recurrence in group 2 than that in group 1 (P = 0.019). Cox multivariable analysis revealed that insulin resistance was an independent predictor of recurrence (hazard ratio 1.287, P = 0.004). Conclusion Our results suggest that insulin resistance promotes LA electrical remodeling and might be related to AF recurrence after PVI.