Key result
Signs of left atrial disease significantly increased the 10-year risk of incident atrial fibrillation from 3.4% to 13.4% in patients with cardiovascular risk factors.
Why the study?
The contribution of left atrial disease and excessive supraventricular ectopic activity to incident AF risk is incompletely understood.
Do signs of left atrial disease and excessive supraventricular ectopic activity predict incident atrial fibrillation in patients with cardiovascular risk factors?
Cohort (n=148)
Do signs of left atrial disease and excessive supraventricular ectopic activity predict incident atrial fibrillation in patients with cardiovascular risk factors?
Absolute Event Rate: 13.4% vs 3.4%
p-value: p=0.04
Elevated NT-proBNP and excessive premature atrial contractions independently predict the 10-year risk of incident atrial fibrillation in patients with cardiovascular risk factors, whereas echocardiographic and ECG signs of left atrial enlargement do not.
NT-proBNP and frequent PACs may aid 10-year AF risk stratification in patients with CV factors; hypothesis-generating, needs prospective validation.
Background The contribution of left atrial disease and excessive supraventricular ectopic activity (ESVEA) to the risk for incident atrial fibrillation (AF) is incompletely understood. Objective To analyse the ten-year risk to develop AF in patients with cardiovascular risk factors and to define the impact of parameters of left atrial disease and ESVEA on AF risk. Methods 148 patients from the Diast-CHF trial with at least one cardiovascular risk factor and free of AF at baseline were followed for 10 years. Left atrial disease was defined as left atrial volume index (LAVI) >35 ml/m 2 , P-terminal force in lead V 1 (PTFV 1 ) >4000 ms*μV or elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) >250 pg/ml. We analyzed the association of these parameters and ESVEA (either >720 premature atrial contractions (PAC) or one atrial run >20 beats per day) on AF-free survival. Results After ten years, AF was newly detected in twelve patients (13.4%) with signs of left atrial disease and two patients (3.4%) without signs of left atrial disease (p = 0.04). LAVI (p = 0.005), ESVEA (p = 0.016) and NT-proBNP (p = 0.010) were significantly associated with AF-free survival in univariate analysis. A combined Cox model of left atrial disease parameters showed associations for NT-proBNP (HR 3.56; 95%CI 1.33–5.31; p = 0.04) and PAC (HR 2.66; 95%CI 1.25–10.15; p = 0.01) but not for LAVI or PTFV 1 with AF-free survival. Conclusion The risk for AF is higher in patients with cardiovascular risk factors and signs of left atrial disease. NT-proBNP and premature atrial contractions independently predict AF-free survival. The role of excessive supraventricular ectopic activity for the assessment of AF risk may be underestimated and requires further study.
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Uhe et al. (2022) conducted a cohort in Cardiovascular risk factors (n=148). Signs of left atrial disease vs. No signs of left atrial disease was evaluated on Incident atrial fibrillation (p=0.04). Signs of left atrial disease significantly increased the 10-year risk of incident atrial fibrillation from 3.4% to 13.4% in patients with cardiovascular risk factors.
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