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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

Authors
 Hee Tae Yu  ;  Jihei Sara Lee  ;  Tae?Hoon Kim  ;  Jae?Sun Uhm  ;  Boyoung Joung  ;  Geu?Ru Hong  ;  Moon?Hyoung Lee  ;  Chi Young Shim  ;  Hui?Nam Pak 
Citation
 JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol.5(7) : 003361, 2016 
Journal Title
 JOURNAL OF THE AMERICAN HEART ASSOCIATION 
Issue Date
2016
MeSH
Aged ; Atrial Appendage/diagnostic imaging ; Atrial Appendage/physiopathology* ; Atrial Fibrillation/complications ; Atrial Fibrillation/diagnostic imaging ; Atrial Fibrillation/physiopathology* ; Atrial Fibrillation/surgery ; Atrial Remodeling/physiology* ; Catheter Ablation ; Echocardiography ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Myocardial Contraction/physiology* ; Sex Factors ; Stroke/etiology ; Stroke/physiopathology* ; Stroke/prevention & control ; Tomography, X-Ray Computed
Keywords
atrial fibrillation ; remodeling ; sex ; stroke
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.
DOI
10.1161/JAHA.116.003361
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/151668
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