title: Echocardiographic predictors of atrial fibrillation in patients with heart failure with preserved ejection fraction.
abstract: OBJECTIVE
  To determine if markers of diastolic dysfunction are associated with atrial fibrillation (AF) development among patients with heart failure with preserved ejection fraction (HFpEF).
  
  
  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.
  
  
  CONCLUSIONS
  Diastolic parameters of left atrial function possibly are more important markers of AF risk than left atrial dilation in HFpEF.
authors.affiliation: Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Woodruff Memorial Building, Atlanta, GA 30322, USA.
authors.forename: Wesley T
authors.initials: WT
authors.lastname: O'Neal
authors.affiliation: Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Woodruff Memorial Building, Atlanta, GA 30322, USA.
authors.forename: Pratik
authors.initials: P
authors.lastname: Sandesara
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Venkatesh
authors.affiliation: Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Woodruff Memorial Building, Atlanta, GA 30322, USA.
authors.forename: Ayman
authors.initials: A
authors.lastname: Samman-Tahhan
authors.affiliation: Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Woodruff Memorial Building, Atlanta, GA 30322, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Hammadah
authors.affiliation: Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Woodruff Memorial Building, Atlanta, GA 30322, USA.
authors.forename: Heval M
authors.initials: HM
authors.lastname: Kelli
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.|Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D004311:Double-Blind Method; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D013148:Spironolactone / Q000627:therapeutic use; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis
chemical_list: D013148:Spironolactone
keywords: atrial fibrillation; echocardiogram; heart failure; preserved ejection fraction