左心房心外膜脂肪组织对急性非瓣膜病心房颤动患者电复律后复发的影响

Effect of epicardial adipose tissue of left Atrium on recurrence of acute nonvalvular atrial fibrillation after cardioversion

目的评价CHA2DS2VASc评分0~1分急性非瓣膜病心房颤动(ANVAF)患者左心房心外膜脂肪组织(LA-EAT)与电复律后复发的相关性.方法纳入CHA2DS2VASc评分0~1分行电复律的ANVAF患者180例,电复律后随访终点为3个月,根据动态心电图结果是否存在心房颤动(房颤)分为维持窦性心律组(对照组,n=79例)和复发组(n=101例),收集两组复律前后临床基线特征,复律后经64排多层螺旋CT重建左心房、肺静脉前庭及左心耳,测定LA-EAT总体积及各区域体积.结果复发组病程、体重指数、平均心室率、第7d复发房颤及LA-EAT体积高于对照组(P<0.05).两组后壁与顶部区域LA-EAT体积最大(P<0.01),侧壁+左心耳区域LA-EAT体积次之(P<0.05),复发组侧壁+左心耳、前壁、后壁及顶部区域LA-EAT体积均高于对照组(P<0.05).多因素logistic回归分析显示LA-EAT体积(OR=2.25,95%CI1.61~4.33,P<0.01)及第7天复发房颤(OR=1.34,95%CI1.09~2.92,P<0.05)是预测CHA2DS2VASc评分0~1分ANVAF患者电复律后复发的独立危险因素.结论CHA2DS2VASc评分0~1分ANVAF电复律后复发患者后壁及顶部区域LA-EAT体积较大,LA-EAT体积增大可增加电复律后短期复发风险.

Objective Our objective was to investigate the relationship between the left atrial epicardial adipose tissue(LA-EAT)and recurrence after electrical cardioversion among patients of acute nonvalvular atrial fibrillation(ANVAF)with CHA2DS2VASc 0 or 1.Methods 180 ANVAF patients of CHA2DS2VASc 0 or 1 underwent electrical cardioversion were enrolled and were divided into sinus rhythm maintenance group(SRMG,n=79)and recurrence group(RG,n=101)according to results of 24-hour Holter monitoring at the 3 months follow-up.Clinical characteristics of all patients were evaluated pre and post electrical cardioversion.After the left atrium,ostium of pulmonary veins and left atrial appendage(LAA)were reconstructed with 64-slice CT,the volume of total and each region of LA-EAT were measured post electrical cardioversion.Results Patients in RG were more likely to have longer disease course,higher body mass index and mean ventricular rate,and higher recurrence rate in day 7 and level of volume of LA-EAT(P<0.05).Highest LA-EAT volume was located in posterior and roof regions following with lateral and LAA region in both groups(P<0.01).LA-EAT volume in lateral and LAA region,anterior and posterior wall,and roof in RG were higher than those in SRMG(P<0.05).Multiple logistic regression analysis showed that volume of LA-EAT(OR=2.25,95%CI 1.61~4.33,P<0.01)and recurrence rate at day 7(OR=1.34,95%Cl 1.09~2.92,P<0.05)were independent risk factors.Conclusion LA-EAT,mainly distributing in posterior and roof regions and higher volume of LA-EAT increase the recurrence in short temi after electrical cardioversion in patients with ANVAF with CHA2DS2VASc 0 or 1.