Full Citation
Title: Association of Right Ventricular Afterload with Atrial Fibrillation Risk in Older Adults: The Atherosclerosis Risk in Communities Study.
Citation Type: Journal Article
Publication Year: 2022
ISBN:
ISSN: 0012-3692
DOI: 10.1016/J.CHEST.2022.05.004
NSFID:
PMCID:
PMID:
Abstract: <h2>ABSTRACT</h2><h3>Background</h3><p>Atrial fibrillation (AF) is widely perceived to originate from the left atrium (LA). It is unclear whether increases in right ventricular (RV) afterload in older adults plays an etiological role in AF genesis independent of LA and left ventricular (LV) remodeling.</p><h3>Research Question</h3><p>Is higher RV afterload associated with greater AF risk independent of LA and LV remodeling?</p><h3>Study Design and Methods</h3><p>In this observational prospective study, we included 2246 community-dwelling older adults (mean age, 75 years) without known cardiovascular disease, with LV ejection fraction >50%, LA volume index <34 ml/m<sup>2</sup>, and E/e' ratio <14 and a measurable functional tricuspid regurgitation jet velocity. From 2D-echocardiograms, we estimated pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR). We ascertained incident AF (through 2018) from hospital discharge codes and death certificates. We estimated hazard ratios (HR) by Cox regression.</p><h3>Results</h3><p>During follow-up (median 6.3 years, interquartile interval 5.5-6.9 years), 215 participants developed AF. AF risk was significantly higher in the third (vs first) tertile of PASP [HR 1.65, 95% confidence interval (CI) 1.08 - 2.54] and PVR [HR 1.38, 95% CI 1.00 - 2.08] independent of LA and LV structure and function, heart rate, body mass index, prevalent sleep apnea, systemic blood pressure, antihypertensive medications, lung, kidney, and thyroid function. These associations persisted after further exclusion of participants with tricuspid regurgitation jet velocity >2.8 m/s and lateral and septal mitral annular velocity above age- and sex-specific reference limits.</p><h3>Interpretation</h3><p>In older adults, higher RV afterload is associated with greater AF risk independent of LA and LV remodeling. Future research should focus on confirming this novel association and elucidate underlying mechanisms.</p>
Url: http://journal.chestnet.org/article/S0012369222008996/fulltext
Url: http://journal.chestnet.org/article/S0012369222008996/abstract
Url: https://journal.chestnet.org/article/S0012-3692(22)00899-6/abstract
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Authors: Parikh, Romil R.; Norby, Faye L.; Wang, Wendy; Thenappan, Thenappan; Prins, Kurt W.; Hof, Jeremy R. Van’t; Lutsey, Pamela L.; Solomon, Scott D.; Shah, Amil M.; Chen, Lin Yee
Periodical (Full): CHEST
Issue: 0
Volume: 0
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