Abstract
Introduction: The absence of abnormalities found on noninvasive cardiac assessment possibly confers a reduced atrial fibrillation (AF) risk despite the presence of traditional risk factors. Methods: We examined the clinical utility of normal findings on routine noninvasive cardiac assessment in 5,331 (85% white; 57% women) from the Cardiovascular Health Study (CHS) who were free of baseline AF. The combination of normal electrocardiogram (ECG) + normal echocardiogram was assessed for the development of AF events. Normal ECG was defined as absence of major or minor Minnesota code abnormalities. Normal echocardiogram was defined as absence of contractile dysfunction, wall motion abnormalities, or abnormal left ventricular mass. Cox regression was used to compute the 10-year risk of developing AF. Results: There were 1,788 (34%) participants with normal ECG + normal echocardiogram, 2,207 (41%) with either normal ECG or a normal echocardiogram, and 1,336 (25%) with abnormal ECG + abnormal echocardiogram. During the 10-year study period, a total of 951 (18%) AF events were detected. When we examined the predictive ability of the normal ECG (multivariable HR=0.80, 95%CI=0.69, 0.92) and normal echocardiogram (multivariable HR=0.75, 95%CI=0.65, 0.87) in isolation, each marker was protective of developing AF. Compared with participants who had abnormal ECG + abnormal echocardiogram (referent), a protective benefit was observed for those with normal ECG or normal echocardiogram (multivariable HR=0.81, 95%CI=0.69, 0.95) and normal ECG + normal echocardiogram (multivariable HR=0.66, 95%CI=0.55, 0.79). Conclusions: Normal findings on routine noninvasive cardiac assessment identify persons in which the risk of AF is low. Further studies are needed to explore the utility of this profile regarding the decision to implement certain risk factor modification strategies in older adults to reduce the burden of AF.
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