Abstract 15871: Predictive Impact of Serum Aldosterone Levels on the Progression from Paroxysmal into Chronic Atrial Fibrillation
Background: Upstream therapy may have the potential to decrease the incidence of atrial fibrillation (Af). Aldosterone has been reported as one of the risk factors of Af. However, roles of aldosterone system and risk factors of chronic Af are still unclear. We therefore evaluated predictive value of serum aldosterone levels on the progression from paroxysmal into permanent Af.
Methods: The levels of serum aldosterone were quantified in a prospective cohort study of 474 consecutive outpatient clinic patients with paroxysmal Af (277 men, 197 women, age 70.8±12.6). The subjects were divided into two groups of elevated aldosterone group (group H) and non-elevated aldosterone group (group L) according to the median value of baseline serum aldosterone for data analysis. The primary end point of the study was development of chronic Af was defined as more than 6 months lasting Af. The secondary end point was cardiac death and hospitalization for heart failure.
Results: The median value of baseline aldosterone was 12.55 ng/dL in all patients. During a median follow-up of 797 days (interquartile range, 414 to 1098), 47 patients progressed from paroxysmal to chronic atrial fibrillation (9.9%). Patients of group H (n=237) with higher serum levels of aldosterone (≥12.55 ng/dL) had a significantly higher incidence of the development of permanent Af , as compared to those of group L (n=237) with lower serum levels of aldsoternoe (15.2% vs. 4.6%, p<0.0001). Although the mean age of the group H was lower than those of the group L, there was no significant difference of cardiac mortality and heart failure required hospitalization among 2 groups (20.1% vs. 22.0%, 31.8% vs. 32.3%, respectively). Elevated aldosterone were independent predictor of increased future chronic Af risk in Cox regression analyses adjusted for age, sex, body mass index, C-reactive protein, brain natriuretic peptide and eGFR. The adjusted hazard ratio of higher aldosterone was 4.461 (95% CI, 2.258–8.812; p<0.0001).
Conclusions: In Japanese outpatient clinic patients with paroxysmal Af, higher serum levels of aldosterone was independent predictor of development of permanent Af. Although the cause of aldosterone level elevation remains unclear, raised aldosterone may be one of the risk factors of chronic Af.
- © 2010 by American Heart Association, Inc.