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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

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      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 CHA 2 DS 2VASc scores beyond sex category. LAAFV 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 LAAFV ( 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 LAAFV ( 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.

      Related collections

      Most cited references 31

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      Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.

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        Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group

        In observational studies, investigators have no control over the treatment assignment. The treated and non-treated (that is, control) groups may have large differences on their observed covariates, and these differences can lead to biased estimates of treatment effects. Even traditional covariance analysis adjustments may be inadequate to eliminate this bias. The propensity score, defined as the conditional probability of being treated given the covariates, can be used to balance the covariates in the two groups, and therefore reduce this bias. In order to estimate the propensity score, one must model the distribution of the treatment indicator variable given the observed covariates. Once estimated the propensity score can be used to reduce bias through matching, stratification (subclassification), regression adjustment, or some combination of all three. In this tutorial we discuss the uses of propensity score methods for bias reduction, give references to the literature and illustrate the uses through applied examples.
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          2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association.

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            Author and article information

            Affiliations
            [ 1 ]Yonsei University Health System SeoulKorea
            Author notes
            [* ] Correspondence to: Hui‐Nam Pak, MD, PhD or Chi Young Shim, MD, PhD, 50 Yonsei‐ro, Seodaemun‐gu, Seoul, Korea 120‐752. E‐mails: hnpak@ 123456yuhs.ac ; cysprs@ 123456yuhs.ac
            [†]

            Dr Yu and Dr Lee contributed equally to this work.

            Journal
            J Am Heart Assoc
            J Am Heart Assoc
            10.1002/(ISSN)2047-9980
            JAH3
            ahaoa
            Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
            John Wiley and Sons Inc. (Hoboken )
            2047-9980
            11 July 2016
            July 2016
            : 5
            : 7 ( doiID: 10.1002/jah3.2016.5.issue-7 )
            27402232 5015374 10.1161/JAHA.116.003361 JAH31639
            © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

            This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

            Counts
            Pages: 9
            Product
            Funding
            Funded by: Korea Health 21 R&D Project
            Award ID: A085136
            Funded by: Ministry of Health and Welfare
            Funded by: National Research Foundation of Korea
            Award ID: NRF‐2013R1A2A2A01014634
            Funded by: Ministry of Science, ICT & Future Planning
            Categories
            Original Research
            Original Research
            Arrhythmia and Electrophysiology
            Custom metadata
            2.0
            jah31639
            July 2016
            Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.4 mode:remove_FC converted:01.09.2016

            Cardiovascular Medicine

            atrial fibrillation, stroke, sex, remodeling

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