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

Teresa S.M. Tsang, Bernard J. Gersh, Christopher P. Appleton, A. Jamil Tajik, Marion E. Barnes, Kent R. Bailey, Jae K. Oh, Cynthia Leibson, Samantha C. Montgomery, James B. Seward

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1636-1644
Number of pages9
JournalJournal of the American College of Cardiology
Volume40
Issue number9
DOIs
StatePublished - Nov 6 2002

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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