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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

Scatterplot of patients with a history of stroke or TIA based on their LAA mechanical function and LA volume index in each sex. A, In women, the majority of patients with a history of cerebrovascular accidents showed advanced electroanatomical remodeling of LA (mean value of LA volume index: 39.4 mL/m2; LAA‐FV [flow velocity]: 47.3 cm/s). B, In men, however, no such distribution was observed (mean value of LA volume index: 35.0 mL/m2; LAA‐FV: 50.1 cm/s). LA indicates left atrium; LAA, left atrial appendage; TIA, transient ischemic attack.
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jah31639-fig-0002: Scatterplot of patients with a history of stroke or TIA based on their LAA mechanical function and LA volume index in each sex. A, In women, the majority of patients with a history of cerebrovascular accidents showed advanced electroanatomical remodeling of LA (mean value of LA volume index: 39.4 mL/m2; LAA‐FV [flow velocity]: 47.3 cm/s). B, In men, however, no such distribution was observed (mean value of LA volume index: 35.0 mL/m2; LAA‐FV: 50.1 cm/s). LA indicates left atrium; LAA, left atrial appendage; TIA, transient ischemic attack.

Mentions: When each sex group was divided based on history of stroke or TIA, considerably advanced remodeling was observed in women with a history of stroke or TIA (Table 3). Women with a history of stroke or TIA had a significantly lower LAA‐FV (P<0.001) and LV ejection fraction (P=0.003) in comparison with women without as well as men with a history of ischemic cerebrovascular events (P=0.015 for LAA‐FV; P=0.441 for LV ejection fraction). Likewise, LAVI (P<0.001) and E/Em (P=0.008) were greater in women with a history of stroke or TIA than in women without as well as men with a history of the disease (P<0.001 for LAVI; P=0.103 for E/Em). However, no significant differences in these parameters were observed between men with and without a history of stroke. Once patients with a history of stroke or TIA were plotted on a graph based on their LAVI and LAA‐FV, the majority of female patients had a large LAVI and low LAA‐FV (P<0.001, Figure 2A); however, no such distribution was observed in men (P=0.596, Figure 2B). Furthermore, a multivariable logistic regression analysis using interaction term between sex and LAVI (female sex×LAVI) or LAA‐FV (female sex×LAA‐FV) showed that a history of stroke or TIA has significant associations with LA volume index (adjusted odds ratio [OR], 1.038; 95% CI, 1.003–1.075; P=0.035) or LAA‐FV (adjusted OR, 0.976; 95% CI, 0.952–0.999; P=0.047) among women than among men (Table 4). Usage of anticoagulant at the time of stroke or TIA event was comparable between men and women (6.8% vs 4.4%; P=0.999).


Advanced Left Atrial Remodeling and Appendage Contractile Dysfunction in Women Than in Men Among the Patients With Atrial Fibrillation: Potential Mechanism for Stroke
Scatterplot of patients with a history of stroke or TIA based on their LAA mechanical function and LA volume index in each sex. A, In women, the majority of patients with a history of cerebrovascular accidents showed advanced electroanatomical remodeling of LA (mean value of LA volume index: 39.4 mL/m2; LAA‐FV [flow velocity]: 47.3 cm/s). B, In men, however, no such distribution was observed (mean value of LA volume index: 35.0 mL/m2; LAA‐FV: 50.1 cm/s). LA indicates left atrium; LAA, left atrial appendage; TIA, transient ischemic attack.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

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

jah31639-fig-0002: Scatterplot of patients with a history of stroke or TIA based on their LAA mechanical function and LA volume index in each sex. A, In women, the majority of patients with a history of cerebrovascular accidents showed advanced electroanatomical remodeling of LA (mean value of LA volume index: 39.4 mL/m2; LAA‐FV [flow velocity]: 47.3 cm/s). B, In men, however, no such distribution was observed (mean value of LA volume index: 35.0 mL/m2; LAA‐FV: 50.1 cm/s). LA indicates left atrium; LAA, left atrial appendage; TIA, transient ischemic attack.
Mentions: When each sex group was divided based on history of stroke or TIA, considerably advanced remodeling was observed in women with a history of stroke or TIA (Table 3). Women with a history of stroke or TIA had a significantly lower LAA‐FV (P<0.001) and LV ejection fraction (P=0.003) in comparison with women without as well as men with a history of ischemic cerebrovascular events (P=0.015 for LAA‐FV; P=0.441 for LV ejection fraction). Likewise, LAVI (P<0.001) and E/Em (P=0.008) were greater in women with a history of stroke or TIA than in women without as well as men with a history of the disease (P<0.001 for LAVI; P=0.103 for E/Em). However, no significant differences in these parameters were observed between men with and without a history of stroke. Once patients with a history of stroke or TIA were plotted on a graph based on their LAVI and LAA‐FV, the majority of female patients had a large LAVI and low LAA‐FV (P<0.001, Figure 2A); however, no such distribution was observed in men (P=0.596, Figure 2B). Furthermore, a multivariable logistic regression analysis using interaction term between sex and LAVI (female sex×LAVI) or LAA‐FV (female sex×LAA‐FV) showed that a history of stroke or TIA has significant associations with LA volume index (adjusted odds ratio [OR], 1.038; 95% CI, 1.003–1.075; P=0.035) or LAA‐FV (adjusted OR, 0.976; 95% CI, 0.952–0.999; P=0.047) among women than among men (Table 4). Usage of anticoagulant at the time of stroke or TIA event was comparable between men and women (6.8% vs 4.4%; P=0.999).

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