Background

Height-based indexations for the evaluation of left atrial (LA) volumes have been proposed as an alternative method to account for body stature when body composition is abnormal. The aim of this study was to derive reference values for these indexation methods and to examine their association with atrial fibrillation (AF).

Methods

A healthy population was randomly split into derivation and validation cohorts (n = 493 each). The derivation cohort was used to derive reference values for iso- and allometric height-indexed LA volumes. Echocardiography included measurement of maximal LA volume (LAV_max) and minimal LA volume (LAV_min). Associations between these measures and AF were investigated in the validation cohort. Cox proportional-hazards regression was performed, adjusting for CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology Atrial Fibrillation) risk score.

Results

From 986 healthy subjects, allometric height-indexed exponents were determined to 1.72 and 1.56 for LAV_max and LAV_min, respectively. Upper reference values were determined to be LAV_max > 22.1 mL/m^1.72 and LAV_min > 12.7 mL/m^1.56. In the validation cohort, 41 patients (8%) developed AF during follow-up (median, 14.7 years). In unadjusted analyses, both isometric and allometric indexed LAV_max were associated with AF (hazard ratio, 1.07 [95% CI, 1.03-1.11; P < .001] and 1.11 [95% CI, 1.05-1.18; P < .001] per 1 mL/m and 1 mL/m^1.72 increase, respectively) with equal C statistics of 0.63. Height-indexed LAV_min was also associated with AF, with higher C statistics than for LAV_max. All findings were consistent after multivariable adjustment. LAV_max > 22.1 mL/m^1.72 posed an increased risk for AF (hazard ratio, 4.65; 95% CI, 1.83-11.86), but LAV_min > 12.7 mL/m^1.56 carried a higher risk (hazard ratio, 6.33; 95% CI, 2.66-15.07).

Conclusions

Both isometric and allometric height-indexed LA volumes are associated with AF in the general population. LAV_min is more strongly associated with AF than LAV_max regardless of indexation.

中文翻译：

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等长和异长高度索引左心房大小与心房颤动之间的关联

背景

已经提出了用于评估左心房 (LA) 体积的基于高度的指数化作为在身体成分异常时解释身体身材的替代方法。本研究的目的是为这些索引方法得出参考值，并检查它们与心房颤动 (AF) 的关系。

方法

健康人群被随机分成推导和验证队列（每个n  = 493）。推导队列用于推导等长和异速生长指数 LA 体积的参考值。超声心动图包括测量最大 LA 体积 (LAV _max ) 和最小 LA 体积 (LAV _min )。在验证队列中研究了这些措施与 AF 之间的关联。进行 Cox 比例风险回归，调整 CHARGE-AF（基因组流行病学心房颤动中的心脏和衰老研究队列）风险评分。

结果

_{从 986 名健康受试者中，LAV max}和 LAV _min的异速身高指数分别确定为 1.72 和 1.56 。上参考值被确定为 LAV _max > 22.1 mL/m ^1.72和 LAV _min > 12.7 mL/m ^1.56。在验证队列中，41 名患者 (8%) 在随访期间（中位时间为 14.7 年）发展为 AF。在未经调整的分析中，等长和异速指示的 LAV _max均与 AF 相关（风险比，1.07 [95% CI，1.03-1.11；P  < .001] 和 1.11 [95% CI，1.05-1.18；P  < .001]每 1 mL/m 和 1 mL/m ^1.72分别增加），相等的 C 统计量为 0.63。高度索引的 LAV _min也与 AF 相关，其 C 统计数据高于 LAV _max。多变量调整后，所有结果均一致。LAV _max > 22.1 mL/m ^1.72会增加 AF 的风险（风险比，4.65；95% CI，1.83-11.86），但 LAV _min > 12.7 mL/m ^1.56的风险更高（风险比，6.33；95% CI，2.66-15.07）。

结论

在一般人群中，等长和异长高度指数的 LA 体积都与 AF 相关。无论指数化如何，LAV _min与 AF 的相关性都比 LAV _max强。