Minimum vs. maximum left atrial volume for prediction of first atrial fibrillation or flutter in an elderly cohort: a prospective study
Minimum vs. maximum left atrial volume for prediction of first atrial fibrillation or flutter in an elderly cohort: a prospective study
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DOI：
10.1093/ejechocard/jen235
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发表时间：
2009-03-01
影响因子：
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通讯作者：
Tsang, Teresa S. M.
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文献类型：
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作者：
Fatema, Kaniz;Barnes, Marion E.;Tsang, Teresa S. M.
我们试图比较最小和最大左心房（LA）容积对首次房颤（AF）/扑动发展的预测能力和可重复性，这项前瞻性研究包括574名成人，平均年龄74 ± 6岁，窦性心律，既往无房性心律失常病史或证据。在平均1.9 +/- 1.2年的随访期间，30例（5.2%）首次发生AF/扑动。根据最小和最大左心房容积的三分位数，无房颤/房扑的3年风险估计值分别为97、87和74%（P < 0.0006）和94、85和78%（P = 0.03）。最小左心房容积随房颤/房扑预测的临床和其他超声心动图参数增加[每三分位数，风险比（HR）2.4]，在单独模型中最大左心房容积（每三分位数，HR 1.8）也是如此。当两种容量输入同一模型并调整协变量时，最小而非最大LA容量保持显著性。然而，就观察者间的可重复性而言，最大左心房容积更有利（平均差异3.1 ± 7.1 vs. 7.4 ± 7.3 mL/m2）。最小左心房容积是首次房颤/房扑的独立预测因子。虽然它在预测能力方面略上级最大左心房容积，但观察者间变异性更大。
We sought to compare the predictive power and reproducibility between minimum and maximum left atrial (LA) volume for the development of first atrial fibrillation (AF)/flutter.This prospective study included 574 adults, mean age 74 +/- 6 years, in sinus rhythm, and had no history or evidence of prior atrial arrhythmias. During a mean follow-up of 1.9 +/- 1.2 years, 30 (5.2%) developed first AF/flutter. The 3-year risk estimates of freedom from AF/flutter by tertiles of minimum and maximum LA volumes were, respectively, 97, 87, and 74% (P < 0.0006) and 94, 85, and 78% (P = 0.03). Minimum LA volume was incremental to clinical and other echocardiographic parameters of AF/flutter prediction [per tertile, hazard ratio (HR) 2.4], as was maximum LA volume (per tertile, HR 1.8) in a separate model. When both volumes were entered into the same model and adjusting for covariates, minimum but not maximum LA volume retained significance. However, in terms of interobserver reproducibility, maximum LA volume compared more favourably (mean difference 3.1 +/- 7.1 vs. 7.4 +/- 7.3 mL/m(2)).Minimal LA volume was an independent predictor of first AF/flutter. Although it was marginally superior to maximal LA volume in terms of predictive ability, the interobserver variability was greater.