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.
Few data exist regarding the relationship between diastolic function and NVAF.
The clinical and echocardiographic characteristics of patients age > or =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.
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.