Abstract
BackgroundLeft ventricular diastolic dysfunction has been shown to associate with increased risk of atrial fibrillation (AF). We aimed to examine the predictors of AF in individuals with preclinical diastolic dysfunction (PDD) - diastolic dysfunction without clinical heart failure – and develop a risk score in this population.MethodsPatients underwent echocardiogram from December 2009 to December 2015 showing left ventricular ejection fraction (LVEF) ≥ 50% and grade 1 diastolic dysfunction, without clinical heart failure, valvular heart disease or AF were included. Outcome was defined as new onset AF. Cumulative probabilities were estimated and multivariable adjusted competing-risks regression analysis was performed to examine predictors of incident AF. A predictive score model was constructed.ResultsA total of 9591 PDD patients (mean age 66, 41% men) of racial/ethnical diversity were included in the study. During a median follow-up of 54 months, 455 (4.7%) patients developed AF. Independent predictors of AF included advanced age, male sex, race, hypertension, diabetes, and peripheral artery disease. A risk score including these factors showed a Wolber’s concordance index of 0.65 (0.63–0.68, p < 0.001), suggesting a good discrimination.ConclusionsOur study revealed a set of predictors of AF in PDD patients. A simple risk score predicting AF in PDD was developed and internally validated. The scoring system could help clinical risk stratification, which may lead to prevention and early treatment strategies.
Highlights
Left ventricular diastolic dysfunction has been shown to associate with increased risk of atrial fibrillation (AF)
Patients characteristics A total of 9591 patients with grade 1 diastolic dysfunction were included in the study
There was no difference in the use of individual anti-hypertensive medications between the group with incident AF and the rest of the cohort
Summary
Left ventricular diastolic dysfunction has been shown to associate with increased risk of atrial fibrillation (AF). We aimed to examine the predictors of AF in individuals with preclinical diastolic dysfunction (PDD) - diastolic dysfunction without clinical heart failure – and develop a risk score in this population. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population [1], and is associated with increased risk of stroke, cardiovascular events, heart failure and mortality [2], profoundly impacting on both individual’s quality of life and health care burden [2, 3]. We aimed to: 1) investigate the predicting factors of new-onset AF in our multiracial cohort of patients with PDD, and 2) construct a risk score that predicts incidence of AF using available clinical variables
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