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Abstract：
BACKGROUND: Atrial fibrillation (AF) can be a cause and consequence of cardiac remodeling. The natural history of remodeling associated with AF is incompletely described.
OBJECTIVE: The purpose of this study was to describe the frequency and timing of AF-associated echocardiographic changes.
METHODS: Patients within the Duke University Health System with ≥2 transthoracic echocardiograms (TTEs) performed between 2005 and 2018 were evaluated. Patients with AF and normal baseline TTEs were matched to patients without AF on year of TTE, age, and CHA2DS2-VASc score. Frequency and timing of changes in chamber size, ventricular function, mitral regurgitation, and all-cause mortality were compared over 5 years of follow-up.
RESULTS: The cohort included 3299 patients with AF at baseline and 7613 controls without AF. Normal baseline TTEs were acquired from 730 of patients with AF; 727 of these patients were matched to controls without AF. Patients with AF had higher rates of left atrial enlargement (hazard ratio [HR] 1.53; 95% confidence interval 1.27-1.85; P < .001), left ventricular (LV) systolic dysfunction (HR 1.80; 95% confidence interval 1.00-3.26; P = .045), LV diastolic dysfunction (HR 1.51; 95% confidence interval 1.08-2.10; P = .01), and moderate or greater mitral regurgitation (HR 2.09; 95% confidence interval 1.27-3.43; P = .003) than did controls. Atrial enlargement, systolic dysfunction, and mitral regurgitation surpassed the rates seen in controls within 6-12 months, whereas differences in diastolic dysfunction emerged at 24 months. There were no differences in ventricular sizes or mortality.
CONCLUSIONS: AF is associated with higher rates of left atrial enlargement, LV systolic and diastolic dysfunction, and mitral regurgitation that typically manifest within 6-24 months of diagnosis. The natural history of cardiac remodeling in patients with AF may inform treatment decisions and facilitate patient-tailored care.
OBJECTIVE: The purpose of this study was to describe the frequency and timing of AF-associated echocardiographic changes.
METHODS: Patients within the Duke University Health System with ≥2 transthoracic echocardiograms (TTEs) performed between 2005 and 2018 were evaluated. Patients with AF and normal baseline TTEs were matched to patients without AF on year of TTE, age, and CHA2DS2-VASc score. Frequency and timing of changes in chamber size, ventricular function, mitral regurgitation, and all-cause mortality were compared over 5 years of follow-up.
RESULTS: The cohort included 3299 patients with AF at baseline and 7613 controls without AF. Normal baseline TTEs were acquired from 730 of patients with AF; 727 of these patients were matched to controls without AF. Patients with AF had higher rates of left atrial enlargement (hazard ratio [HR] 1.53; 95% confidence interval 1.27-1.85; P < .001), left ventricular (LV) systolic dysfunction (HR 1.80; 95% confidence interval 1.00-3.26; P = .045), LV diastolic dysfunction (HR 1.51; 95% confidence interval 1.08-2.10; P = .01), and moderate or greater mitral regurgitation (HR 2.09; 95% confidence interval 1.27-3.43; P = .003) than did controls. Atrial enlargement, systolic dysfunction, and mitral regurgitation surpassed the rates seen in controls within 6-12 months, whereas differences in diastolic dysfunction emerged at 24 months. There were no differences in ventricular sizes or mortality.
CONCLUSIONS: AF is associated with higher rates of left atrial enlargement, LV systolic and diastolic dysfunction, and mitral regurgitation that typically manifest within 6-24 months of diagnosis. The natural history of cardiac remodeling in patients with AF may inform treatment decisions and facilitate patient-tailored care.
摘要：
背景：心房颤动（AF）可能是心脏重塑的原因和后果。未完全描述与AF相关的重塑的自然史。
目的：描述房颤相关超声心动图变化的频率和时间。
方法：评估了2005-2018年间在杜克大学卫生系统内进行两次或更多次经胸超声心动图（TTE）的患者。基线TTE正常的房颤患者与TTE年无房颤患者相匹配，年龄,和CHA2DS2-VASc评分。腔室大小变化的频率和时间，心室功能,二尖瓣反流,在5年的随访中比较了全因死亡率.
结果：该队列包括3,299例基线房颤患者和7,613例无房颤患者。在730名AF患者中观察到正常的基线TTE；这些患者中的727名与无AF的对照组相匹配。房颤患者的LA增大率较高（HR1.53[1.27-1.85]，p<0.001)，左心室收缩功能障碍（HR1.80[1.00-3.26]，p=0.045),左心室舒张功能障碍（HR1.51[1.08-2.10]，p=0.01）和中度或更大的二尖瓣反流（HR2.09[1.27-3.43]，p=0.003）与对照组相比。心房扩大,收缩功能障碍,二尖瓣反流在6-12个月内超过了对照组的比率；然而，舒张功能障碍在24个月时出现差异.心室大小或死亡率没有差异。
结论：房颤与较高的LA增大率相关，左心室收缩和舒张功能障碍，和二尖瓣反流通常在诊断后6-24个月内出现。房颤患者心脏重塑的自然史可以为治疗决策提供信息，并促进患者量身定制的护理。
目的：描述房颤相关超声心动图变化的频率和时间。
方法：评估了2005-2018年间在杜克大学卫生系统内进行两次或更多次经胸超声心动图（TTE）的患者。基线TTE正常的房颤患者与TTE年无房颤患者相匹配，年龄,和CHA2DS2-VASc评分。腔室大小变化的频率和时间，心室功能,二尖瓣反流,在5年的随访中比较了全因死亡率.
结果：该队列包括3,299例基线房颤患者和7,613例无房颤患者。在730名AF患者中观察到正常的基线TTE；这些患者中的727名与无AF的对照组相匹配。房颤患者的LA增大率较高（HR1.53[1.27-1.85]，p<0.001)，左心室收缩功能障碍（HR1.80[1.00-3.26]，p=0.045),左心室舒张功能障碍（HR1.51[1.08-2.10]，p=0.01）和中度或更大的二尖瓣反流（HR2.09[1.27-3.43]，p=0.003）与对照组相比。心房扩大,收缩功能障碍,二尖瓣反流在6-12个月内超过了对照组的比率；然而，舒张功能障碍在24个月时出现差异.心室大小或死亡率没有差异。
结论：房颤与较高的LA增大率相关，左心室收缩和舒张功能障碍，和二尖瓣反流通常在诊断后6-24个月内出现。房颤患者心脏重塑的自然史可以为治疗决策提供信息，并促进患者量身定制的护理。
