Left atrial structure and function in atrial fibrillation: ENGAGE AF-TIMI 48
Left atrial structure and function in atrial fibrillation: ENGAGE AF-TIMI 48
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DOI：
10.1093/eurheartj/eht500
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发表时间：
2014-06-01
影响因子：
39.3
通讯作者：
Solomon, Scott D.
中科院分区：
文献类型：
--
作者：
Gupta, Deepak K.;Shah, Amil M.;Solomon, Scott D.
目的左心房（LA）结构与功能、心房颤动（AF）电负荷与脑卒中风险之间的复杂关系尚不清楚。方法和结果在ENGAGE AF-TIMI 48超声心动图亚研究中对971名受试者的左房结构和功能进行了评估。左心房大小、排空分数（LAEF）和收缩功能在不同房颤类型（阵发性、持续性或永久性）和CHADS(2)评分中进行比较，作为卒中风险的估计。大多数AF患者（55%）同时存在LA增大和LAEF减小，LA大小与LAEF呈负相关（R = -0.57, P < 0.001）。随着房颤电负荷的增加和CHADS(2)评分的升高，LA大小增加，LAEF下降。此外，19%的AF患者LAEF受损，尽管LA大小正常，超声心动图时，即使在窦性心律的AF患者亚群中也存在LA收缩功能障碍。结论：在当代房颤人群中，LA结构和功能越来越异常，房颤电负荷更大，CHADS(2)评分估计卒中风险更高。此外，尽管LA大小和窦性心律正常，但仍存在LA功能障碍，这表明LA功能的评估可能为房颤患者的评估增加重要的增量信息。
Aims The complex relationship between left atrial (LA) structure and function, electrical burden of atrial fibrillation (AF) and stroke risk is not well understood. We aimed to describe LA structure and function in AF.Methods and results Left atrial structure and function was assessed in 971 subjects enrolled in the echocardiographic substudy of ENGAGE AF-TIMI 48. Left atrial size, emptying fraction (LAEF), and contractile function were compared across AF types (paroxysmal, persistent, or permanent) and CHADS(2) scores as an estimate of stroke risk. The majority of AF patients (55%) had both LA enlargement and reduced LAEF, with an inverse relationship between LA size and LAEF (R = -0.57, P < 0.001). With an increasing electrical burden of AF and higher CHADS(2) scores, LA size increased and LAEF declined. Moreover, 19% of AF subjects had impaired LAEF despite normal LA size, and LA contractile dysfunction was present even among the subset of AF subjects in sinus rhythm at the time of echocardiography.Conclusions In a contemporary AF population, LA structure and function were increasingly abnormal with a greater electrical burden of AF and higher stroke risk estimated by the CHADS(2) score. Moreover, LA dysfunction was present despite normal LA size and sinus rhythm, suggesting that the assessment of LA function may add important incremental information in the evaluation of AF patients.