Aims: To determine if markers of diastolic dysfunction are associated with atrial fibrillation (AF) development among patients with heart failure with preserved ejection fraction (HFpEF).
Methods and results: We examined the association of several echocardiographic measures of diastolic dysfunction with incident AF in 573 patients (mean age = 68 ± 9.5 years; 48% men; 79% white) with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial (TOPCAT) who were free of baseline AF. Echocardiograms were analysed at a core laboratory. Incident AF cases were identified by follow-up study electrocardiograms and review of relevant medical records through May of 2013. Over a median follow-up of 3 years, 40 patients developed AF (incidence rate = 2.2 per 100 person years). Increasing values of the E/A ratio [per 0.1 increase: hazard ratio (HR) = 1.11, 95% confidence interval (CI) = 1.06-1.17], left atrial volume (per 5 mL increase: HR = 1.13, 95% CI = 1.03-1.23), and left atrial area (per 5 cm2 increase: HR = 1.51, 95% CI = 1.03-2.22) were associated with greater risk of AF. The risk of AF decreased with increasing peak A wave velocities (per 10 cm/s increase: HR = 0.83, 95% CI = 0.72-0.96). The risk of AF was not materially altered when peak A wave velocity was further adjusted for left atrial volume (HR = 0.83, 95% CI = 0.71-0.96) and area (HR = 0.83, 95% CI = 0.71-0.96). However, the associations of left atrial volume (HR = 1.10, 95% CI = 0.99-1.22) and area (HR = 1.48, 95% CI = 0.96-2.28) were no longer significant when accounting for peak A wave velocity.
Conclusion: Diastolic parameters of left atrial function possibly are more important markers of AF risk than left atrial dilation in HFpEF.
Keywords: atrial fibrillation; echocardiogram; heart failure; preserved ejection fraction.
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