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Doppler transmitral flow indexes and risk of atrial fibrillation (The Framingham Heart Study)

  • Ramachandran S Vasan
    Correspondence
    Address for reprints: Ramachandran S. Vasan, MD, Framingham Heart Study, 73, Mt. Wayte Avenue, Suite 2, Framingham, Massachusetts 01702-5827, USA.
    Affiliations
    National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA

    Cardiology Section, Boston University School of Medicine, Boston, Massachusetts, USA

    Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, USA
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  • Martin G Larson
    Affiliations
    National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA
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  • Daniel Levy
    Affiliations
    National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA

    Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, USA

    the Divisions of Cardiology and Clinical Epidemiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and the National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
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  • Maurizio Galderisi
    Affiliations
    the Department of Medicine, University of Naples Federico II, Naples, Italy
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  • Philip A Wolf
    Affiliations
    Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, USA

    Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
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  • Emelia J Benjamin
    Affiliations
    National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA

    Cardiology Section, Boston University School of Medicine, Boston, Massachusetts, USA

    Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, USA
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      Abstract

      Atrial fibrillation (AF) is characterized by structural remodeling and atrial systolic failure. It is unclear if atrial filling abnormalities precede the onset of AF. We evaluated 942 Framingham Study subjects (587 women; mean age 75 years) who underwent Doppler echocardiographic evaluation at a routine examination and who did not have a history of AF. We used multivariable Cox regression models (stratified by gender and prevalent cardiovascular disease) to examine the relations of Doppler transmitral flow indexes (ratio of the velocity–time integrals of the early [E] and late [A] diastolic filling waves [VTI E/A], a correlate of atrial conduit function; E-wave deceleration time; the atrial filling fraction, an index of atrial systolic function; and peak A wave velocity) to the incidence of AF. At follow-up (mean 7 years), 85 subjects (41 women) developed AF. In models adjusting for established risk factors for AF (including left atrial size) at baseline, and for heart failure and myocardial infarction on follow-up, a 1 SD increment in VTI E/A was associated with a 28% increase in risk of AF (hazards ratio 1.28, 95% confidence interval 1.02 to 1.59). A 1 SD decrease in the atrial filling fraction was associated with a 28% higher risk of AF (hazards ratio 1.28, 95% confidence interval 0.98 to 1.67). There was a U-shaped relation between peak A-wave velocity and risk of AF. Thus, in our elderly community-based sample, increased VTI E/A and a low atrial filling fraction were markers of increased risk of AF, suggesting that altered atrial filling may antedate AF.
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