Abstract 12133: Diastolic Pulse Wave Analysis in the Prediction of Incident Atrial Fibrillation in The Multi-ethnic Study Of Atherosclerosis
Atrial fibrillation (AF) is the most common arrhythmia. Pulse pressure (PP) is a known risk factor for AF. Large artery elasticity (LAE) is predictive of heart failure beyond blood pressure (BP). We aimed to examine the predictive value of LAE and systemic vascular resistance (SVR) for new onset of AF in the Multi-Ethnic Study of Atherosclerosis (MESA). We studied 6,212 women and men of white, African American, Hispanic and Chinese ethnicity, aged 45-84 years and free of overt cardiovascular disease (CVD), including AF. Participants underwent radial artery tonometry. The waveform portion of LAE was derived from the diastolic pulse contour, while estimated SVR was estimated from age, BP and other characteristics. LAE is the product of the waveform portion*SVR. Incident AF was based on hospitalization record ICD9 and CMS codes. Median follow-up was 7.6 years and 275 events of new onset of AF. Proportional hazards regression analysis was used: Model 1 adjusted for age, race, gender, site, height, while Model 2 adds heart rate, mean arterial BP, PP, anti-hypertensive medications, blood lipids and lipid lowering-medication, smoking, body mass index, diabetes, eGFR < 60ml/min, and self-reported valvular disease and emphysema. In Table 1, Part A, LAE (mean±SD, 13.4±5.6 ml/mmHg*10) had a significant inverse hazard ratio (HR) with AF events. In Part B, the waveform part of LAE (1.57±0.58 seconds) was non-significantly inversely related to AF, while estimated SVR (1646±395 dyne * seconds/cm5) was significantly positively related to AF. All associations were independent of PP, which was strongly positively related to AF. In subjects initially free of overt CVD and AF, lower LAE and higher estimated SVR added prognostic information for AF events beyond PP and other cardiovascular risk factors. These data suggest that the resistance vasculature would contribute more to increased risk for AF than the pool of the large arteries. Table 1: Proportional hazards prediction of incident AF
- © 2012 by American Heart Association, Inc.