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: 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.
  
  
  
  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.
  
  
  
  More-extensive LA remodeling and deterioration in LAA function were noted in women than in men with high calculated risk of stroke in AF.
authors.affiliation: Yonsei University Health System, Seoul, Korea.
authors.forename: Hee Tae
authors.initials: HT
authors.lastname: Yu
authors.affiliation: Yonsei University Health System, Seoul, Korea.
authors.forename: Jihei Sara
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Yonsei University Health System, Seoul, Korea.
authors.forename: Tae-Hoon
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Yonsei University Health System, Seoul, Korea.
authors.forename: Jae-Sun
authors.initials: JS
authors.lastname: Uhm
authors.affiliation: Yonsei University Health System, Seoul, Korea.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.affiliation: Yonsei University Health System, Seoul, Korea.
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
authors.affiliation: Yonsei University Health System, Seoul, Korea.
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Yonsei University Health System, Seoul, Korea hnpak@yuhs.ac cysprs@yuhs.ac.
authors.forename: Chi Young
authors.initials: CY
authors.lastname: Shim
authors.affiliation: Yonsei University Health System, Seoul, Korea hnpak@yuhs.ac cysprs@yuhs.ac.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D064752:Atrial Remodeling / Q000502:physiology*; D017115:Catheter Ablation; D004452:Echocardiography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D012737:Sex Factors; D020521:Stroke / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D014057:Tomography, X-Ray Computed
keywords: atrial fibrillation; remodeling; sex; stroke