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

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

Research output: Contribution to journalArticle

15 Citations (Scopus)

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.

Original languageEnglish
JournalJournal of the American Heart Association
Volume5
Issue number7
DOIs
Publication statusPublished - 2016 Jul 11

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Atrial Remodeling
Atrial Appendage
Atrial Fibrillation
Stroke
Odds Ratio
Catheter Ablation
Transient Ischemic Attack
Vascular Diseases
Sex Characteristics
Diabetes Mellitus
Heart Failure
Hypertension
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{f65f66c10dbc40bea3775147ec39cb7d,
title = "Advanced Left Atrial Remodeling and Appendage Contractile Dysfunction in Women Than in Men Among the Patients With Atrial Fibrillation: Potential Mechanism for 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.",
author = "Yu, {Hee Tae} and Lee, {Jihei Sara} and Kim, {Tae Hoon} and Uhm, {Jae Sun} and Boyoung Joung and Hong, {Geu Ru} and Lee, {Moon Hyoung} and Shim, {Chi Young} and Pak, {Hui Nam}",
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language = "English",
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journal = "Journal of the American Heart Association",
issn = "2047-9980",
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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. / Yu, Hee Tae; Lee, Jihei Sara; Kim, Tae Hoon; Uhm, Jae Sun; Joung, Boyoung; Hong, Geu Ru; Lee, Moon Hyoung; Shim, Chi Young; Pak, Hui Nam.

In: Journal of the American Heart Association, Vol. 5, No. 7, 11.07.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Advanced Left Atrial Remodeling and Appendage Contractile Dysfunction in Women Than in Men Among the Patients With Atrial Fibrillation

T2 - Potential Mechanism for Stroke

AU - Yu, Hee Tae

AU - Lee, Jihei Sara

AU - Kim, Tae Hoon

AU - Uhm, Jae Sun

AU - Joung, Boyoung

AU - Hong, Geu Ru

AU - Lee, Moon Hyoung

AU - Shim, Chi Young

AU - Pak, Hui Nam

PY - 2016/7/11

Y1 - 2016/7/11

N2 - 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.

AB - 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.

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