Guichard Jean-Baptiste, Hupin David, Pichot Vincent, Berger Mathieu, Celle Sébastien, Borràs Roger, Roca-Luque Ivo, Mont Lluís, Da Costa Antoine, Barthélémy Jean-Claude, Roche Frédéric
Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Carrer Villaroel, 170, 08036 Barcelona, Catalonia, Spain.
Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Carrer Rosselló 149-153, 08036 Barcelona, Catalonia, Spain.
Eur Heart J Open. 2025 Mar 19;5(3):oeaf030. doi: 10.1093/ehjopen/oeaf030. eCollection 2025 May.
Screening the general population aged 65 for atrial fibrillation (AF) has been proposed as a preventive measure against potential complications. Metrics derived from heart rate variability (HRV) that depict heart rate fragmentation (HRF) have been suggested to reflect autonomic nervous system dysfunction. The aim of the study was to assess the predictive capacity of HRV markers, including HRF, for AF occurrence over an 18-year follow-up and to develop a predictive score for AF onset among the general population aged 65 at the study's inception.
The PROOF prospective cohort consisted of 1011 subjects aged 65 with no history of AF nor history of cardiovascular disease. A 24 h Holter-electrocardiogram was performed at baseline and HRV, from which HRV indices using temporal, frequency, and non-linear methods, and the percentage of inflection points (PIPs) were calculated. The PROOF cohort demonstrated a cumulative incidence of AF of 13.0% during a median follow-up of 17.8 years. Male gender, hypertension, decreased heart rate and α1, and increased premature atrial complex burden, PNN50, and PIP were independent predictors of AF occurrence. Subsequently, the PROOF-AF risk score was developed, ranging from 0 to 7, providing interesting predictive capacity [area under the curve (AUC) = 70.1%, negative predictive value = 92.0%, and accuracy = 72.0%]. The high-risk group (PROOF-AF score from 5 to 7) and the intermediate-risk group (PROOF-AF score from 2 to 4) exhibited a 16.8- and 5.4-fold higher risk, respectively, of developing AF.
Heart rate fragmentation parameters, included in the PROOF-AF score, may be used to identify healthy individuals aged 65 who are at high risk of developing AF and assist population screening.
对65岁普通人群进行房颤（AF）筛查已被提议作为预防潜在并发症的一项措施。有研究表明，源自心率变异性（HRV）且描述心率碎裂（HRF）的指标可反映自主神经系统功能障碍。本研究旨在评估包括HRF在内的HRV标志物在18年随访期内对AF发生的预测能力，并为研究开始时年龄为65岁的普通人群开发一个AF发病预测评分。
PROOF前瞻性队列研究纳入了1011名65岁且无AF病史和心血管疾病史的受试者。在基线时进行24小时动态心电图检查，计算HRV，包括使用时域、频域和非线性方法得出的HRV指标以及拐点百分比（PIP）。在中位随访期17.8年期间，PROOF队列中AF的累积发病率为13.0%。男性、高血压、心率降低、α1降低、房性早搏负担增加、PNN50增加和PIP增加是AF发生的独立预测因素。随后，开发了PROOF-AF风险评分，范围为0至7，具有良好的预测能力[曲线下面积（AUC）=70.1%，阴性预测值=92.0%，准确率=72.0%]。高风险组（PROOF-AF评分为5至7）和中风险组（PROOF-AF评分为2至4）发生AF的风险分别高出16.8倍和5.4倍。
PROOF-AF评分中包含的心率碎裂参数可用于识别65岁患AF高风险的健康个体，并有助于人群筛查。
