Habitual modest alcohol consumption led to mechanical LA substrate formation, worsened by ALDH2 variants, and impaired LA booster function predicted AF (adjusted 1.68; 95% CI 1.06-2.67; p=0.028).
Cohort (n=249)
Does modest alcohol consumption in ethnic Asians with ALDH2 variants worsen left atrial mechanical substrate formation and increase the risk of atrial fibrillation?
Modest alcohol consumption in ethnic Asians with ALDH2 variants leads to pronounced left atrial mechanical dysfunction, which independently predicts atrial fibrillation.
Estimación del efecto: adjusted 1.68 (95% CI 1.06-2.67)
valor p: p=0.028
Aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism is a common genetic variant in Asians that is responsible for defective toxic aldehyde and lipid peroxidation metabolism after alcohol consumption. The extent to which low alcohol consumption may cause atrial substrates to trigger atrial fibrillation (AF) development in users with ALDH2 variants remains to be determined. We prospectively enrolled 249 ethnic Asians, including 56 non-drinkers and 193 habitual drinkers (135 (70%) as ALDH2 wild-type: GG, rs671; 58 (30%) as ALDH2 variants: G/A or A/A, rs671). Novel left atrial (LA) mechanical substrates with dynamic characteristics were assessed using a speckle-tracking algorithm and correlated to daily alcohol consumption and ALDH2 genotypes. Despite modest and comparable alcohol consumption by the habitual alcohol users (14.3 8.3~28.6 and 12.3 6.3~30.7 g/day for those without and with ALDH2 polymorphism, p = 0.31), there was a substantial and graded increase in the 4-HNE adduct and prolonged PR, and a reduction in novel LA mechanical parameters (including peak atrial longitudinal strain (PALS) and phasic strain rates (reservoir, conduit, and booster pump functions), p < 0.05), rather than an LA emptying fraction (LAEF) or LA volume index across non-drinkers, and in habitual drinkers without and with ALDH2 polymorphism (all p < 0.05). The presence of ALDH2 polymorphism worsened the association between increasing daily alcohol dose and LAEF, PALS, and phasic reservoir and booster functions (all Pinteraction: <0.05). Binge drinking superimposed on regular alcohol use exclusively further worsened LA booster pump function compared to regular drinking without binge use (1.66 ± 0.57 vs. 1.97 ± 0.56 1/s, p = 0.001). Impaired LA booster function further independently helped to predict AF after consideration of the CHARGE-AF score (adjusted 1.68 (95% CI: 1.06–2.67), p = 0.028, per 1 z-score increment). Habitual modest alcohol consumption led to mechanical LA substrate formation in an ethnic Asian population, which was more pronounced in subjects harboring ALDH2 variants. Impaired LA booster functions may serve as a useful predictor of AF in such populations.
Hung et al. (Thu,) conducted a cohort in Atrial fibrillation (n=249). Habitual modest alcohol consumption and ALDH2 variants vs. Non-drinkers and ALDH2 wild-type was evaluated on Prediction of AF by impaired LA booster function (per 1 z-score increment) (adjusted 1.68, 95% CI 1.06-2.67, p=0.028). Habitual modest alcohol consumption led to mechanical LA substrate formation, worsened by ALDH2 variants, and impaired LA booster function predicted AF (adjusted 1.68; 95% CI 1.06-2.67; p=0.028).