Renal disease and left atrial remodeling predict atrial fibrillation in patients with cardiovascular risk factors.
OBJECTIVE
In this prospective population-based study, we tested the possible interaction between chronic kidney disease (CKD) and left atrium volume index (LAVI) in predicting incident atrial fibrillation (AF).


METHODS
We enrolled 3549 Caucasian subjects, 1829 men and 1720 women, aged 60.7 ± 10.6 years, without baseline AF and thyroid disorders. Echocardiographic left ventricular mass and LAVI were measured. Renal function was calculated by estimated glomerular filtration rate (e-GFR). To test the effect of some clinical confounders on incident AF, we constructed different models including clinical and laboratory parameters. AF diagnosis was made by standard electrocardiogram or 24-h ECG-Holter, hospital discharge diagnoses, and by the all-clinical documentation.


RESULTS
During the follow-up (53.3 ± 18.1 months), 546 subjects developed AF (4.5 events/100 patient-years). Progressors to AF were older, had a higher body mass index, blood pressure, LDL-cholesterol, glucose, cardiac mass, and LAVI, and had lower e-GFR. Hypertension, metabolic syndrome, diabetes, cardiac hypertrophy and CKD were more common among AF cases than controls. In the final Cox regression model, variables that remained significantly associated with AF were: cardiac hypertrophy (HR=1.495, 95% CI=1.215-1.841), renal disease (HR=1.528, 95% CI=1.261-1.851), age (HR=1.586, 95% CI=1.461-1.725) and LAVI (HR=2.920, 95% CI=2.426-3.515). The interaction analysis demonstrated a synergic effect between CKD and cardiac hypertrophy (HR=4.040, 95% CI=2.661-6.133), as well as between CKD and LAVI (HR=4.875, 95% CI=2.699-8.805). The coexistence of all three subclinical organ damages significantly increases the arrhythmic risk (HR=7.185, 95% CI=5.041-10.240).


CONCLUSIONS
Our data demonstrate that LAVI and CKD significantly interact in a synergic manner in increasing AF risk.
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
Angela
A
Sciacqua
Experimental and Clinical Medicine Experimental and Clinical Medicine.
Maria
M
Perticone
CNR, Istituto di Biomedicina, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
Giovanni
G
Tripepi
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
Sofia
S
Miceli
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
Eliezer J
EJ
Tassone
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
Nadia
N
Grillo
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
Giuseppe
G
Carullo
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
Giorgio
G
Sesti
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy. Electronic address: perticone@unicz.it.
Francesco
F
Perticone
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology; D064752:Atrial Remodeling / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology; D012307:Risk Factors
Atrial fibrillation; Atrial volume; Chronic kidney disease; Left ventricular hypertrophy