|Title||Association of Right Ventricular Afterload With Atrial Fibrillation Risk in Older Adults: The Atherosclerosis Risk in Communities Study.|
|Publication Type||Journal Article|
|Year of Publication||2022|
|Authors||Parikh RR, Norby FL, Wang W, Thenappan T, Prins KW, Hof JRVan't, Lutsey PL, Solomon SD, Shah AM, Chen LYee|
|Date Published||2022 May 11|
BACKGROUND: Atrial fibrillation (AF) is widely perceived to originate from the left atrium (LA). Whether increases in right ventricular (RV) afterload in older adults play an etiological role in AF genesis independent of LA and left ventricular (LV) remodeling is unknown.
RESEARCH QUESTION: Is higher RV afterload associated with greater AF risk independent of LA and LV remodeling?
STUDY DESIGN AND METHODS: In this observational prospective study, we included 2,246 community-dwelling older adults (mean age, 75 years) without known cardiovascular disease, with LV ejection fraction > 50%, LA volume index < 34 mL/m, 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.
RESULTS: 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% 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, BMI, prevalent sleep apnea, systemic BP, antihypertensive medications, and 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.
INTERPRETATION: 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.
|Grant List||K08 HL140100 / HL / NHLBI NIH HHS / United States |
R01 HL158795 / HL / NHLBI NIH HHS / United States
R01 HL162927 / HL / NHLBI NIH HHS / United States