Association of preserved ratio impaired spirometry and restrictive spirometric pattern with incident atrial fibrillation: a cohort study

Q: What are the key findings of this study?

Preserved ratio impaired spirometry was significantly associated with a higher risk of incident atrial fibrillation (aOR 2.12) compared to individuals with normal spirometry.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Incident Atrial Fibrillation (n=2219). Intervention: Preserved ratio impaired spirometry (PRISm) vs. Non-PRISm (FEV1 ≥ 80% predicted). Primary outcome: Incident atrial fibrillation (aOR 2.12, 95% CI 1.35-3.31, p=0.001).

Q: What does this research mean for the field?

Preserved ratio impaired spirometry and restrictive spirometric pattern, particularly when concurrent, are independently associated with an increased risk of incident atrial fibrillation in adults without airflow limitation. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Xiu Shi; Yifei Chen; Bing Su; Yunfan Wang; Lijie Yang; Hanxiang Nie

doi:10.1038/s41533-026-00573-8

October 14, 2026npj Primary Care Respiratory MedicineOpen Access

Association of preserved ratio impaired spirometry and restrictive spirometric pattern with incident atrial fibrillation: a cohort study

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Key result

Preserved ratio impaired spirometry linked to ~2.1-fold higher risk of incident AF.

aOR 2.12
95% CI 1.35-3.31
P=0.001
n=2,219

Why the study?

No studies had examined the association of preserved ratio impaired spirometry (PRISm) or restrictive spirometric pattern (RSP) with incident atrial fibrillation (AF).

Does preserved ratio impaired spirometry (PRISm) or restrictive spirometric pattern (RSP) increase the risk of incident atrial fibrillation in adults without baseline airflow limitation?

Key Points

To examine whether preserved ratio impaired spirometry (PRISm) or restrictive spirometric pattern (RSP) is associated with incident atrial fibrillation in adults without airflow limitation.
Analyzed 2219 participants (mean age 62.4 years, 43.6% male) without baseline atrial fibrillation or airflow limitation, evaluating PRISm and RSP as binary exposures and as four mutually exclusive spirometric categories.
Handled missing covariates across 20 imputed datasets using multiple imputation by chained equations, pooling logistic regression models adjusted for demographics, lifestyle, comorbidities, and cardiac medications using Rubin's rules.
Over follow-up, 247 incident atrial fibrillation cases (11.1%) occurred, with binary PRISm (41/168 [24.4%] vs 206/2051 [10.0%]; aOR = 2.12, 95% CI 1.35–3.31, P = 0.001) and binary RSP (51/191 [26.7%] vs 196/2028 [9.7%]; aOR = 2.38, 95% CI 1.58–3.60, P < 0.001) demonstrating significantly elevated odds.
In mutually exclusive comparisons against normal spirometry (193/1994 [9.7%]), concurrent PRISm+RSP remained strongly associated with incident AF (38/134 [28.4%]; aOR = 2.62, 95% CI 1.63–4.22, P < 0.001), whereas PRISm alone (3/34 [8.8%]; aOR = 0.77, 95% CI 0.21–2.81, P = 0.690) and RSP alone (13/57 [22.8%]; aOR = 1.88, 95% CI 0.93–3.80, P = 0.077) were not statistically significant.

Study Design

Type

Cohort (n=2,219)

Multicenter

Yes

Structured PICO

Does preserved ratio impaired spirometry (PRISm) or restrictive spirometric pattern (RSP) increase the risk of incident atrial fibrillation in adults without baseline airflow limitation?

P

Population

2,219 adults aged 40 years and older without prevalent atrial fibrillation or airflow limitation, followed for up to 11 years.

E

Exposure

Preserved ratio impaired spirometry (PRISm, defined as FEV1/FVC ≥0.70 with FEV1 < 80% predicted) and restrictive spirometric pattern (RSP, defined as FEV1/FVC ≥0.70 with FVC < 80% predicted). Evaluated both as binary exposures and as mutually exclusive categories.

C

Comparator

Participants without PRISm, without RSP, or those with normal spirometry (FEV1/FVC ≥0.70, FEV1 ≥80% predicted, FVC ≥80% predicted).

O

Outcome

Incident atrial fibrillation, identified on a 12-lead electrocardiogram (ECG) obtained at the second SHHS exam or adjudicated by the parent cohorts anytime between baseline polysomnography and the final follow-up date of June 30, 2006.hard clinical

Main Result

Odds Ratio: 2.12 (95% CI 1.35–3.31)

Absolute Event Rate: 24.4% vs 10%

p-value: p=0.001

Limitations

Exact dates of atrial fibrillation onset were unavailable, precluding time-to-event analyses.
A substantial proportion of participants were excluded due to missing data, potentially leading to selection bias.
The cohort was predominantly White and older, which may limit the generalizability of the findings.
Echocardiographic and other structural or functional cardiac measures were unavailable.
Restrictive spirometric pattern was defined from spirometry alone without measurement of total lung capacity.
The absence of repeated spirometry measurements precluded assessment of the stability of the spirometric phenotypes.
The analysis did not account for the competing risk of death before atrial fibrillation onset.
Exact AF onset dates were unavailable, precluding accounting for the competing risk of death before AF
Small sample sizes in the mutually exclusive PRISm-alone and RSP-alone groups
A single baseline spirometric measurement may not fully capture long-term dynamic phenotype transitions

Implication

In a community-based adult population without airflow limitation, both preserved ratio impaired spirometry (PRISm) and restrictive spirometric patterns (RSP) are independently associated with an increased risk of incident atrial fibrillation.

Abstract

Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of atrial fibrillation (AF). To our knowledge, no studies have examined the association of preserved ratio impaired spirometry (PRISm) or restrictive spirometric pattern (RSP) with incident AF. We included participants without prevalent AF who had incident AF ascertainment and available spirometry and excluded those with airflow limitation. PRISm and RSP were evaluated as binary exposures and as four mutually exclusive spirometric patterns. Missing covariates were handled using multiple imputation by chained equations, and logistic regression estimates were pooled using Rubin’s rules. Sensitivity analyses used an individual lower limit of normal (LLN) for the forced expiratory volume in 1 s (FEV 1 )/forced vital capacity (FVC) ratio, complete-case analysis, and an alternative smoking model including pack-years and current smoking. A total of 2219 participants were included, with a mean age of 62.4 years, of whom 43.6% were male. During follow-up, 247 incident AF events (11.1%) were recorded. In fully adjusted models, PRISm was associated with incident AF (adjusted odds ratio [aOR] = 2.12, 95% confidence interval [CI] 1.35–3.31, P = 0.001), and RSP was also associated with incident AF (aOR = 2.38, 95% CI 1.58–3.60, P < 0.001). When participants were categorized into four mutually exclusive groups, PRISm+RSP remained associated with incident AF (aOR = 2.62, 95% CI 1.63–4.22, P < 0.001), whereas PRISm alone (aOR = 0.77, 95% CI 0.21–2.81, P = 0.690) and RSP alone (aOR = 1.88, 95% CI 0.93–3.80, P = 0.077) were not statistically significant. Results were consistent in sensitivity analyses. Among adults without airflow limitation, binary PRISm and RSP were associated with higher odds of incident AF. In mutually exclusive analyses, the clearest association was observed in participants with concurrent reductions in FEV 1 and FVC.

Discussion

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Cite This Study

Shi et al. (2026) conducted a cohort in Incident Atrial Fibrillation (n=2,219). Preserved ratio impaired spirometry (PRISm) vs. Non-PRISm (FEV1 ≥ 80% predicted) was evaluated on Incident atrial fibrillation (aOR 2.12, 95% CI 1.35-3.31, p=0.001). Preserved ratio impaired spirometry was significantly associated with a higher risk of incident atrial fibrillation (aOR 2.12) compared to individuals with normal spirometry.

synapsesocial.com/papers/6ad2187bfc66cec880534ea4 https://doi.org/10.1038/s41533-026-00573-8

Topics

Atrial fibrillation

Persistent AF management

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Association of preserved ratio impaired spirometry and restrictive spirometric pattern with incident atrial fibrillation: a cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Association of preserved ratio impaired spirometry and restrictive spirometric pattern with incident atrial fibrillation: a cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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