Left ventricular diastolic dysfunction is associated with atrial remodeling and risk or presence of stroke in patients with paroxysmal atrial fibrillation

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• 作者：Tae-Hoon Kim ; MD ; Chi Young Shim ; MD ; PhD ; Jae Hyung Park ; PhD ; Chung Mo Nam ; PhD ; Jae-Sun Uhm ; MD ; Boyoung Joung ; MD ; PhD ; Moon-Hyoung Lee ; MD ; PhD ; Hui-Nam Pak ; MD ; PhD ; ^{hnpak@yuhs.ac" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Atrial fibrillation ; Left ventricular filling pressure ; Catheter ablation ; Stroke
• 刊名：Journal of Cardiology
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：68
• 期：2
• 页码：104-109
• 全文大小：1095 K

文摘

Although the degree of electroanatomical remodeling of the left atrium (LA) is influenced by left ventricular (LV) diastolic function, clinical implications of estimated LV filling pressure (E/Em) are limited in patients with atrial fibrillation (AF). We hypothesized that increased E/Em is related to an advanced LA remodeling, a high CHA₂DS₂-VASc score, and the presence of stroke or transient ischemic attack (TIA) in patients with paroxysmal AF.

Methods

We included 1098 patients with paroxysmal AF (male 74.5%, 57.6 ± 11.3 years old) who underwent AF catheter ablation. We compared E/Em to clinical parameters, echocardiography, and three-dimensional-computed tomography findings.

Results

The E/Em > 15 group (n = 98) was older (p < 0.001) and had more females (p < 0.001), greater LA volume index (p < 0.001), higher CHA₂DS₂-VASc score (p < 0.001), and stroke/TIA prevalence (p = 0.001) than groups with an E/Em of 8–15 (n = 676) or <8 (n = 324). An E/Em was independently associated with the presence of stroke/TIA (OR 1.638, 95% CI 1.050–2.554, p = 0.030) after adjusting for age, sex, body surface area, LA volume index, and LA appendage volume index.

Conclusions

In patients with paroxysmal AF, the elevated LV filling pressure estimated by E/Em is independently associated with the presence of stroke or TIA.