Association of Right Ventricular Afterload With Atrial Fibrillation Risk in Older Adults: The Atherosclerosis Risk in Communities Study

Romil R. Parikh, Faye L. Norby, Wendy Wang, Thenappan Thenappan, Kurt W. Prins, Jeremy R. Van't Hof, Pamela L. Lutsey, Scott D. Solomon, Amil M. Shah, Lin Yee Chen

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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/m2, 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.

Original languageEnglish (US)
Pages (from-to)884-893
Number of pages10
JournalCHEST
Volume162
Issue number4
DOIs
StatePublished - Oct 2022
Externally publishedYes

Keywords

  • aging
  • atrial fibrillation
  • pulmonary circulation
  • pulmonary hypertension
  • right ventricle

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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