Author:
Rossello Xavier,Ramallal Raúl,Romaguera Dora,Alonso-Gómez Ángel M.,Alonso Alvaro,Tojal-Sierra Lucas,Fernández-Palomeque Carlos,Martínez-González Miguel Ángel,Garrido-Uriarte María,López Luis,Díaz Agnes,Zaldua-Irastorza Olatz,Shah Amit J.,Salas-Salvadó Jordi,Fitó Montserrat,Toledo Estefania
Abstract
ABSTRACTAimsTo evaluate the effect of an intensive lifestyle intervention (ILI) on the structural and functional cardiac substrate of atrial fibrillation (AF) in overweight or obese people with metabolic syndrome (MetS).MethodsParticipants of the PREDIMED-PLUS trial (n=6874) were randomised 1:1 to an ILI program based on an energy-reduced Mediterranean diet, increased physical activity, and cognitive-behavioural weight management, or to a control intervention of low-intensity dietary advice. Left atrial (LA) strain, function, and volumes were evaluated by a core echocardiography lab in 534 participants at baseline, 3-year and 5-year follow-up. Mixed models were used to evaluate the effect of the ILI on LA structure and function.ResultsIn the subsample, baseline mean age was 65 years (SD 5 years), and 40% of the participants were women. Over the 5-year period, both groups experienced worsening of LA structure and function, with increases in LA volumes and stiffness index and decreases in LA longitudinal strain, LA function index and LA emptying fraction over time. Changes in the ILI and control group were not significantly different for any of the primary outcomes (LA emptying fraction: -0.95% (95%CI -0.93, -0.98) in control group, -0.97% (95%CI -0.94, -1.00) in ILI group, pbetween groups=0.80; LA longitudinal strain: 0.82% (95%CI 0.79, 0.85) in control group, 0.85% (95%CI 0.82, 0.89) in ILI group, pbetween groups=0.24) or any of the secondary outcomes.ConclusionsIn overweight or obese people with MetS, an ILI had no impact on the underlying structural and functional left atrial substrate measurements associated with AF risk.
Publisher
Cold Spring Harbor Laboratory
Reference34 articles.
1. ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the Europe;Eur Heart J,2020
2. Rozen G , Hosseini SM , Kaadan MI , Biton Y , Heist EK , Vangel M , et al. Emergency Department Visits for Atrial Fibrillation in the United States: Trends in Admission Rates and Economic Burden From 2007 to 2014. J Am Heart Assoc 2018;7.
3. PREVEntion and regReSsive Effect of weight-loss and risk factor modification on Atrial Fibrillation: the REVERSE-AF study;Europace,2018
4. Left atrial structure and function are associated with cardiovascular outcomes independent of left ventricular measures: a UK Biobank CMR study;Eur Heart J Cardiovasc Imaging,2022
5. Obesity and Atrial Fibrillation Prevalence, Pathogenesis, and Prognosis