Abstract 16354: Heart Murmur is a Strong Predictor for the Incidence of Atrial Fibrillation in a General Urban Cohort: The Suita Study
Background: Heart murmur is an important finding as a simple screening of non-rheumatic valvular disease, which is a risk factor for atrial fibrillation (AF). However, there are few studies on the relation between the presence of heart murmur and the incidence of AF. We assessed the hypothesis that heart murmur is a useful marker for incident AF in an urban general population in Japan.
Methods: A total of 6,918 participants (30 to 84 years old) initially free of AF were prospectively followed up for incident AF in the Suita Study. Standard 12-lead electrocardiograms were obtained from all subjects in the supine position. Each record was coded independently by 2 well-trained physicians using the Minnesota Code. Participants were diagnosed with AF if AF or atrial flutter was present on electrocardiograms obtained during a biannual routine health examination or if AF was indicated as a present illness by either annual questionnaire responses or participants’ medical records. The presence of a systolic or diastolic heart murmur was identified during the physical examination by a trained clinician using a stethoscope. Blood pressures (BP) were taken as the average of the second and third measurements. BP categories were defined by the following criteria: normal BP (<120/80 mm Hg), prehypertension (120 to 139/80 to 89 mm Hg), and hypertension (≥140/90 mm Hg and/or antihypertensive medications). Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were analyzed after adjusting for age, sex, body mass index, diabetes, PB categories, hyperlipidemia, smoking, and drinking at baseline.
Results: In 87,171 person-years of follow-up, 241 incident AF events occurred. Compared with non-murmur subjects, the adjusted HRs (95% CIs) of incident AF were 2.81 (1.29 to 6.10) for men, 2.66 (1.30 to 5.45) for women, and 2.72 (1.61 to 4.58) for both sexes. The adjusted HRs (95% CIs) of incident AF were 1.93 (1.05 to 3.56) for hypertensive subjects without murmur, 3.63 (1.49 to 8.87) and 3.01 (1.04 to 8.68) for prehypertensive and hypertensive subjects with murmur, respectively, compared with normal BP and non-murmur subjects.
Conclusions: Auscultation for heart murmur is a good screening predictor for incident AF in a general population.
- © 2013 by American Heart Association, Inc.