Relationship Between Periodontitis and Atrial Fibrosis in Atrial Fibrillation Histological Evaluation of Left Atrial Appendages
Relationship Between Periodontitis and Atrial Fibrosis in Atrial Fibrillation Histological Evaluation of Left Atrial Appendages
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DOI：
10.1016/j.jacep.2022.08.018
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发表时间：
2023-01-23
影响因子：
7
通讯作者：
Nakano, Yukiko
中科院分区：
文献类型：
--
作者：
Miyauchi, Shunsuke;Nishi, Hiromi;Nakano, Yukiko
背景技术心房纤维化导致心房颤动(AF)和AF相关中风的发作和持续。牙周炎是一种常见的感染性、炎症性疾病，会加重一些全身性疾病。然而，牙周炎与房颤和心房纤维化之间的关系仍不清楚。 目的 作者旨在通过研究切除的左心耳 (LAA) 来阐明牙周炎与心房纤维化之间的关系。 方法 76 名 AF 患者（55 名非阵发性 AF，25 名二尖瓣反流，18 名 LAA 血栓）接受预定治疗前瞻性招募了在心脏手术期间接受左心耳切除术的患者。所有患者均接受口腔检查，以剩余牙齿数量、探诊出血、牙周探诊深度和牙周炎症表面积（PISA）作为牙周炎的参数进行评估。通过 Azan-Mallory 染色量化每个左心耳的纤维化程度。 结果 探诊出血（R = 0.48；P < 0.0001）、牙周探诊深度 >= 4 mm（R = 0.26；P = 0.02）和 PISA（R = 0.46；P < 0.0001）与心房纤维化呈正相关。在剩余牙齿>10颗的患者中，PISA与心房纤维化呈正相关且强相关（R = 0.57；P < 0.0001）。在调整年龄、房颤持续时间、BMI、二尖瓣反流和 CHADS(2)（充血性心力衰竭、高血压、年龄、糖尿病、既往中风/短暂性脑缺血发作）评分后，PISA 与心房纤维化显着相关（β = 0.016；P = 0.0002）。 结论 作者从组织学角度揭示了牙周炎与心房纤维化的关联。这表明可改变的牙周炎可能是房颤的危险因素。 （J Am Coll Cardiol EP 2023；9:43-53）(c) 2023 年，美国心脏病学会基金会。
BACKGROUND Atrial fibrosis contributes to the onset and persistence of atrial fibrillation (AF) and AF-related stroke. Periodontitis, a common infectious and inflammatory disease, aggravates some systemic diseases. However, the association of periodontitis with AF and with atrial fibrosis has remained unclarified.OBJECTIVES The authors aimed to elucidate the relationship between periodontitis and atrial fibrosis by studying resected left atrial appendages (LAAs).METHODS Seventy-six patients with AF (55 with nonparoxysmal AF, 25 with mitral valve regurgitation, 18 with LAA thrombus) who were scheduled to undergo LAA excision during cardiac surgery were prospectively enrolled. All patients underwent an oral examination, and the remaining number of teeth, bleeding on probing, periodontal probing depth, and periodontal inflamed surface area (PISA) were evaluated as parameters of periodontitis. The degree of fibrosis in each LAA was quantified by Azan-Mallory staining.RESULTS Bleeding on probing (R = 0.48; P < 0.0001), periodontal probing depth of >= 4 mm (R = 0.26; P = 0.02), and PISA (R = 0.46; P < 0.0001) were positively correlated with atrial fibrosis. Among patients with >10 remaining teeth, PISA was positively and strongly correlated with atrial fibrosis (R = 0.57; P < 0.0001). After adjustments for age, AF duration, BMI, mitral valve regurgitation, and CHADS(2) (congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack) score, PISA was significantly associated with atrial fibrosis (beta = 0.016; P = 0.0002).CONCLUSIONS The authors histologically revealed the association of periodontitis with atrial fibrosis. This indicates that periodontitis, which is modifiable, is likely a risk factor for AF. (J Am Coll Cardiol EP 2023;9:43-53) (c) 2023 by the American College of Cardiology Foundation.