Beth Israel Deaconess Medical Center, Cardiovascular Institute, 185 Pilgrim Road, Baker 4, Boston, MA 02215, USA.
Eur Heart J. 2012 Apr;33(7):904-12. doi: 10.1093/eurheartj/ehr378. Epub 2011 Oct 11.
Atrial fibrillation (AF) is the most common sustained arrhythmia in the elderly, and shares several risk factors with diastolic dysfunction, including hypertension and advanced age. The purpose of this study is to examine diastolic dysfunction as a risk for incident AF.
We examined the association of echocardiographic parameters of diastolic function with the incidence of AF in 4480 participants enrolled in the Cardiovascular Health Study, an ongoing cohort of community-dwelling older adults from four US communities. Participants underwent baseline echocardiography in 1989-1990 and were followed for incident AF on routine follow-up and hospitalizations. After 50 941 person-years of follow-up (median follow-up time 12.1 years), 1219 participants developed AF. In multivariable-adjusted age-stratified Cox models, diastolic echocardiographic parameters were significantly associated with the risk of incident AF. The most significant parameters were the Doppler peak E-wave velocity and left atrial diameter, which demonstrated a positive nonlinear association [HR 1.5 (CI 1.3-1.9) and HR 1.7 (CI 1.4-2.1) for highest vs. lowest quintile, respectively], and Doppler A-wave velocity time integral, which displayed a U-shaped relationship with the risk of AF [HR 0.7 (CI 0.6-0.9) for middle vs. lowest quintile]. Each diastolic parameter displayed a significant association with adjusted NT-proBNP levels, although the nature of the association did not entirely parallel the risk of AF. Further cluster analysis revealed unique patterns of diastolic function that may identify patients at risk for AF.
In a community-based population of older adults, echocardiographic measures of diastolic function are significantly associated with an increased risk of AF.
心房颤动（AF）是老年人中最常见的持续性心律失常，与舒张功能障碍有几个共同的危险因素，包括高血压和高龄。本研究旨在研究舒张功能障碍作为 AF 发病的危险因素。
我们检查了超声心动图舒张功能参数与 4480 名参加心血管健康研究的参与者的 AF 发生率之间的关联，这是一个来自美国四个社区的社区居住的老年人群的正在进行的队列研究。参与者在 1989-1990 年进行了基线超声心动图检查，并在常规随访和住院期间随访 AF 事件。在 50941 人年的随访（中位随访时间 12.1 年）后，1219 名参与者发生了 AF。在多变量调整的年龄分层 Cox 模型中，舒张超声心动图参数与 AF 发病风险显著相关。最显著的参数是多普勒峰值 E 波速度和左心房直径，它们显示出正的非线性关联[最高五分位与最低五分位相比，HR 为 1.5（CI 1.3-1.9）和 HR 1.7（CI 1.4-2.1）]，以及多普勒 A 波速度时间积分，与 AF 风险呈 U 形关系[中间五分位与最低五分位相比，HR 为 0.7（CI 0.6-0.9）]。每个舒张参数与调整后的 NT-proBNP 水平均有显著相关性，尽管相关性的性质不完全与 AF 风险平行。进一步的聚类分析显示了舒张功能的独特模式，这些模式可能可以识别出有 AF 风险的患者。
在一个基于社区的老年人群中，超声心动图舒张功能测量与 AF 风险增加显著相关。
