title: Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women.
abstract: OBJECTIVE
  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 > 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.
  
  
  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.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. tsang.teresa@mayo.edu
authors.forename: Teresa S M
authors.initials: TS
authors.lastname: Tsang
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Appleton
authors.forename: A Jamil
authors.initials: AJ
authors.lastname: Tajik
authors.forename: Marion E
authors.initials: ME
authors.lastname: Barnes
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Cynthia
authors.initials: C
authors.lastname: Leibson
authors.forename: Samantha C
authors.initials: SC
authors.lastname: Montgomery
authors.forename: James B
authors.initials: JB
authors.lastname: Seward
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality