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J Am Coll Cardiol, 2002; 40:1636-1644
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY: CLINICAL APPLICATION OF ECHOCARDIOGRAPHIC FINDINGS

Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women

Teresa S. M. Tsang, MD, FACC*,*, Bernard J. Gersh, MB, ChB, DPhil, FACC*, Christopher P. Appleton, MD§, A. Jamil Tajik, MD, FACC*, Marion E. Barnes, MS*, Kent R. Bailey, PhD{dagger}, Jae K. Oh, MD, FACC*, Cynthia Leibson, PhD{ddagger}, Samantha C. Montgomery, MS{dagger} and James B. Seward, MD, FACC*

* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
{dagger} Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
{ddagger} Section of Clinical Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
§ Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA

Manuscript received February 20, 2002; revised manuscript received May 15, 2002, accepted July 15, 2002.

* Reprint requests and correspondence: Dr. Teresa S. M. Tsang, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, USA 55905.
tsang.teresa{at}mayo.edu

OBJECTIVES: The objective of this study was to determine whether diastolic dysfunction is associated with increased risk of nonvalvular atrial fibrillation (NVAF) in older adults with no history of atrial arrhythmia.

BACKGROUND: Few data exist regarding the relationship between diastolic function and NVAF.

METHODS: The clinical and echocardiographic characteristics of patients age ≥65 years who had an echocardiogram performed between 1990 and 1998 were reviewed. Exclusion criteria were history of atrial arrhythmia, stroke, valvular or congenital heart disease, or pacemaker implantation. Patients were followed up in their medical records to the last clinical visit or death for documentation of first AF.

RESULTS: Of 840 patients (39% men; mean [± SD] age, 75 ± 7 years), 80 (9.5%) developed NVAF over a mean (± SD) follow-up of 4.1 ± 2.7 years. Abnormal relaxation, pseudonormal, and restrictive left ventricular diastolic filling were associated with hazard ratios of 3.33 (95% confidence interval [CI], 1.5 to 7.4; p = 0.003), 4.84 (95% CI, 2.05 to 11.4; p < 0.001), and 5.26 (95% CI, 2.3 to 12.03; p < 0.001), respectively, when compared with normal diastolic function. After a number of adjustments, diastolic function profile remained incremental to history of congestive heart failure and previous myocardial infarction for prediction of NVAF. Age-adjusted Kaplan-Meier five-year risks of NVAF were 1%, 12%, 14%, and 21% for normal, abnormal relaxation, pseudonormal, and restrictive diastolic filling, respectively.

CONCLUSIONS: The presence and severity of diastolic dysfunction are independently predictive of first documented NVAF in the elderly.

Abbreviations and Acronyms
  AF
  atrial fibrillation
  CAD
  coronary artery disease
  CHF
  congestive heart failure
  DT
  deceleration time
  LA
  left atrium or left atrial
  LV
  left ventricle or left ventricular
  MI
  myocardial infarction
  NVAF
  nonvalvular atrial fibrillation




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