Correlation Of Serum Testosterone With Male Patients With Lone Atrial Fibrillation

BackgroundWith the heavily growth of population aging, the incidence of atrial fibrillation (AF) increases significantly. As the most common arrhythmia in clinical practice, AF accounts for approximately one third of hospitalizations for cardiac rhythm disturbances. Although most cases of AF are associated with reversible causes and specific cardiovascular conditions, some AF occurs in young patients without demonstrable underlying disease, presenting as an isolated or familial arrhythmia. The term lone AF applies to individuals younger than 60y without clinical or echocardiography evidence of cardiopulmonary disease, including hypertension. Few biochemical indicators have been functionally characterized to identify a causal relationship between these indicators and development of lone AF. Numerous studies had shown that the serum testosterone plays an important role in maintaining the normal function of the cardiovascular system. We here sought to determine the clinical impact of testosterone in patients with lone AF.ObjectivesTotal serum testosterone level in lone AF patients and age-matched controls were tested to determine its correlation to the development of lone AF, and to evaluate other possible risked factors related to the pathogenesis of lone AF.MethodsHospitalized male patients were recruited from December 2012 to December 2014, the First Affiliated Hospital of Zhejiang University, College of medicine. LAF group: 100 patients of lone AF, who did not receive any treatment with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-II receptor antagonist (ARB) within last 3 months, were included and divided into paroxysmal AF subgroup (50 cases) and persistent AF subgroup (50 cases). Control group:130 matched patients without AF were included.The blood pressure (BP) and body mass index (BMI) of all cases were measured and then the ultrasonic echocardiography was performed. The total serum testosterone was tested by chemiluminescence method and the high-sensitive C-reactive protein (hs-CRP) level was determined by latex agglutination method.All data are presented as mean values±SD. Statistical significance of the difference between various groups wase valuated by Kruskal-Wallis one-way analysis of variance, and Logistic regression analysis was used to decide the main factor.Results1. Age. the male patients in LAF were older than (55.40±5.79/52.68±7.16 VS 49.54±5.45, P<0.05) the control group,, while there was no significant difference between the paroxysmal AF subgroup and the persistence AF subgroup (55.40±5.79 VS 52.68±7.16, P>0.05).2. Serum testosterone. Compared with the control group, the serum testosterone level of male patients in LAF reduced markedly (383.44±114.19/395.68±96.93 VS 485.27±160.90, P<0.001), while there was no significant difference between the paroxysmal AF subgroup and the persistence AF subgroup (383.44±114.19 VS 395.68±96.93, P>0.05).3. hs-CRP. Compared with the control group, the hs-CRP level of male patients in LAF decreased markedly (3.17±4.49/3.06±4.07 VS 1.18±1.16, P<0.001), while there was no significant difference between the paroxysmal AF subgroup and the persistence AF subgroup (3.17±4.49 VS 3.06±4.07, P>0.05).4. Left atrial diameter (LAD). Measuring with the echocardiography, the LAD of male patients in LAF were longer than (3.17±4.49/3.06±4.07 VS 1.18±1.16, P<0.001) the control group, also there was significant difference between the paroxysmal AF subgroup and the persistence AF subgroup (3.17±4.49 VS 3.06±4.07, P<0.05).5. The age, serum testosterone, hs-CRP and LAD were significantly correlated with LAF according to the Multivariate logistic regression analysis.Conclusions1 It was demonstrated in our study that the serum testosterone markedly decreased in the male patients with LAF and showed no difference between the AF types. The low testosterone may be a predisposing risk factor for lone AF, and the inflammatory factors participated in occurrence and maintenance of the lone AF.2 It was shown in this study that age, hs-CRP and LAD were the independent risk factors, while the testosterone was the independent protective factor.