Association between diastolic dysfunction and future atrial fibrillation in the Tromsø Study from 1994 to 2010

Abstract

ObjectiveTo investigate the association between echocardiographic measurements with emphasis on diastolic dysfunction and risk of atrial fibrillation (AF) in a population-based cohort study.MethodsWe followed 2406 participants from the Tromsø Study from 1994 to 2010. Left atrial (LA) size and mitral Doppler indices as measured by echocardiography were used for evaluating diastolic dysfunction. Information concerning age, systolic blood pressure, height, heart rate, body mass index, total and high-density lipoprotein cholesterol, self-reported use of alcohol, smoking, coffee, physical activity, antihypertensive treatment, prevalent coronary heart disease, valvular heart disease, heart failure, hypertrophy, diabetes and palpitations were obtained at baseline. The outcome measure was clinical AF, documented by an ECG.ResultsAF was detected in 462 subjects (193 women). Mean age at baseline was 62.6 years. Incidence rate of clinical AF was 12.6 per 1000 person-years. In multivariable Cox proportional hazards regression analysis, moderately enlarged LA was associated with 60% (95% CI 1.2 to 2.0) increased risk of AF. Severely enlarged LA had HR for AF of 4.2 (95% CI 2.7 to 6.5) with p value for linear trend <0.001, and the association was similar in both sexes. Abnormal mitral Doppler flow adjusted for predictor variables did not show a statistically significant association with AF risk. However, when LA size was also adjusted for, the risk of AF increased by 30% (95% CI 1.0 to 1.6).ConclusionsOur findings suggest that enlarged LA as a measure for diastolic dysfunction is a significant risk factor for AF in both sexes, and adding measures of abnormal diastolic flow increased the predictive ability significantly.

Almanac 2015: atrial fibrillation research in Heart

“…3 This was independent of other mitral valve Doppler indices of diastolic dysfunction. Left atrial (LA) size increases with increasing diastolic dysfunction due to long-term change in left heart flow dynamics.…”

The relationship of arrhythmias with structural and functional heart changes according to the echocardiography data in the adult population of the Arctic

“…Дилатация ЛП способствует развитию аритмий в связи с увеличением площади для re-entry, развитием фиброза и появлением аритмогенного суб-страта [7,8]. Установлена связь между дилатацией ле-вого предсердия и ФП [12,13]. По данным Gupta и со-авт., размер ЛП увеличен почти у 2/3 пациентов с ФП (у 48% лиц с пароксизмальной, 60% -с персисти-рующей и 77% -с перманентной формой) [3].…”

“…Значимых взаимосвязей между гипертро-фией ЛЖ и ФП не выявлено, что может быть объясне-но разницей в возрастном составе участников (нами об-следовались не только пожилые люди, но и лица более молодого возраста). В литературе имеются сведения о связи между диастолической дисфункцией ЛЖ и не-клапанной ФП [8,13], что согласуется с результатами проведенного исследования. Кроме того, нами уста-новлена значимая взаимосвязь между нарушением диа-столической функции ЛЖ и ЖЭ.…”

Diastolic dysfunction and atrial fibrillation

“…In their Heart paper, Tiwari et al 3 provide further evidence by demonstrating that the addition of LA size and LV diastolic function to a number of sociodemographic variables and cardiovascular risk factors increased the ability of the model to predict the occurrence of AF in 2406 participants of the Tromsø study. During the 16-year follow-up, 462 (19%) individuals presented with AF (incidence: 12.6/1000 person years).…”