Limits...
Advanced Left Atrial Remodeling and Appendage Contractile Dysfunction in Women Than in Men Among the Patients With Atrial Fibrillation: Potential Mechanism for Stroke

View Article: PubMed Central - PubMed

ABSTRACT

Background: The risk of stroke imposed by atrial fibrillation (AF) is significantly greater in women than men; however, the mechanism remains elusive. We hypothesized that left atrial (LA) remodeling and poor contractile function of LA appendage (LAA) would be more predominant in women than men among AF patients.

Methods and results: A total of 579 AF patients (216 women vs age‐, AF type–, and incidences of heart failure, hypertension, diabetes mellitus, stroke or transient ischemic attack, and vascular disease–matched 363 men, 61.3±10.2 years old, 70.1% paroxysmal AF) who underwent AF catheter ablation were included. Sex differences in LA volume index (LAVI) and LAA emptying flow velocity (FV) were analyzed in risk factor 0, 1, and ≥2 groups, according to their CHA2DS2‐VASc scores beyond sex category. LAA‐FV was more significantly reduced in women with risk factor ≥2 than in men of the same risk group (P=0.022). Women showed greater LAVI than their male counterparts in the risk factor ≥2 group (P<0.001). The majority of female patients with a history of stroke had a large LAVI and low LAA‐FV (P<0.001); however, no such distribution was observed in men (P=0.596). LA volume index (odds ratio [OR], 1.038; 95% CI, 1.003–1.075, P=0.035) or LAA‐FV (OR, 0.976; 95% CI, 0.952–0.999; P=0.047) was significantly associated with a history of stroke in women.

Conclusions: More‐extensive LA remodeling and deterioration in LAA function were noted in women than in men with high calculated risk of stroke in AF.

No MeSH data available.


Related in: MedlinePlus

Comparisons of LAA mechanical function (A), LA volume index (B), mean LA endocardial voltage (C), and LAA voltage (D) between men and women of the same stroke risk (predicted by CHA2DS2VASc scores). Sex differences in LAA emptying flow velocity and LA volume index were prominent only among patients with risk factor ≥2. LA indicates left atrium; LAA, left atrial appendage; TIA, transient ischemic attack.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5015374&req=5

jah31639-fig-0001: Comparisons of LAA mechanical function (A), LA volume index (B), mean LA endocardial voltage (C), and LAA voltage (D) between men and women of the same stroke risk (predicted by CHA2DS2VASc scores). Sex differences in LAA emptying flow velocity and LA volume index were prominent only among patients with risk factor ≥2. LA indicates left atrium; LAA, left atrial appendage; TIA, transient ischemic attack.

Mentions: Using echocardiographic and LA voltage measurements, sex differences in electroanatomical remodeling were analyzed in each risk group. Although the risk factor 0 and 1 groups showed no differences in mechanical function of LAA between men and women, the risk factor ≥2 group showed significantly lower LAA‐FV in women (P=0.022; Figure 1A). A similar pattern was observed in anatomical remodeling of LA. LAVI was similar between sexes in risk factor 0 and 1 groups; however, LA was considerably larger in women in the risk factor ≥2 group (P<0.001; Figure 1B). When comparisons of LA endocardial voltage were made among patients whose voltage measurements were available (n=416), endocardial voltage of LA or LAA was lower in women compared to men regardless of risk factor numbers (Figure 1C and 1D). Overall, among patients at a high calculated risk of stroke, anatomical remodeling of LA and contractile dysfunction of LAA were more pronounced in women than in men.


Advanced Left Atrial Remodeling and Appendage Contractile Dysfunction in Women Than in Men Among the Patients With Atrial Fibrillation: Potential Mechanism for Stroke
Comparisons of LAA mechanical function (A), LA volume index (B), mean LA endocardial voltage (C), and LAA voltage (D) between men and women of the same stroke risk (predicted by CHA2DS2VASc scores). Sex differences in LAA emptying flow velocity and LA volume index were prominent only among patients with risk factor ≥2. LA indicates left atrium; LAA, left atrial appendage; TIA, transient ischemic attack.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015374&req=5

jah31639-fig-0001: Comparisons of LAA mechanical function (A), LA volume index (B), mean LA endocardial voltage (C), and LAA voltage (D) between men and women of the same stroke risk (predicted by CHA2DS2VASc scores). Sex differences in LAA emptying flow velocity and LA volume index were prominent only among patients with risk factor ≥2. LA indicates left atrium; LAA, left atrial appendage; TIA, transient ischemic attack.
Mentions: Using echocardiographic and LA voltage measurements, sex differences in electroanatomical remodeling were analyzed in each risk group. Although the risk factor 0 and 1 groups showed no differences in mechanical function of LAA between men and women, the risk factor ≥2 group showed significantly lower LAA‐FV in women (P=0.022; Figure 1A). A similar pattern was observed in anatomical remodeling of LA. LAVI was similar between sexes in risk factor 0 and 1 groups; however, LA was considerably larger in women in the risk factor ≥2 group (P<0.001; Figure 1B). When comparisons of LA endocardial voltage were made among patients whose voltage measurements were available (n=416), endocardial voltage of LA or LAA was lower in women compared to men regardless of risk factor numbers (Figure 1C and 1D). Overall, among patients at a high calculated risk of stroke, anatomical remodeling of LA and contractile dysfunction of LAA were more pronounced in women than in men.

View Article: PubMed Central - PubMed

ABSTRACT

Background: The risk of stroke imposed by atrial fibrillation (AF) is significantly greater in women than men; however, the mechanism remains elusive. We hypothesized that left atrial (LA) remodeling and poor contractile function of LA appendage (LAA) would be more predominant in women than men among AF patients.

Methods and results: A total of 579 AF patients (216 women vs age&#8208;, AF type&ndash;, and incidences of heart failure, hypertension, diabetes mellitus, stroke or transient ischemic attack, and vascular disease&ndash;matched 363 men, 61.3&plusmn;10.2&nbsp;years old, 70.1% paroxysmal AF) who underwent AF catheter ablation were included. Sex differences in LA volume index (LAVI) and LAA emptying flow velocity (FV) were analyzed in risk factor 0, 1, and &ge;2 groups, according to their CHA2DS2&#8208;VASc scores beyond sex category. LAA&#8208;FV was more significantly reduced in women with risk factor &ge;2 than in men of the same risk group (P=0.022). Women showed greater LAVI than their male counterparts in the risk factor &ge;2 group (P&lt;0.001). The majority of female patients with a history of stroke had a large LAVI and low LAA&#8208;FV (P&lt;0.001); however, no such distribution was observed in men (P=0.596). LA volume index (odds ratio [OR], 1.038; 95% CI, 1.003&ndash;1.075, P=0.035) or LAA&#8208;FV (OR, 0.976; 95% CI, 0.952&ndash;0.999; P=0.047) was significantly associated with a history of stroke in women.

Conclusions: More&#8208;extensive LA remodeling and deterioration in LAA function were noted in women than in men with high calculated risk of stroke in AF.

No MeSH data available.


Related in: MedlinePlus