Cardiovascular ultrasound exploration contributes to predict incident atrial fibrillation in arterial hypertension: the Campania Salute Network.

BACKGROUND

Interaction of cardiovascular (CV) risk factors with structural and hemodynamic alterations as combined promoters of atrial fibrillation (AF) is not yet well studied. We designed an observational, longitudinal, retrospective study to predict risk of incident AF by combination of CV risk profile, target organ damage and therapy in hypertensive patients.

METHODS AND

RESULTS

We studied 7062 hypertensive patients without history of AF or prevalent CV disease, with ejection fraction (EF) of ≥50%, and no more than stage III chronic kidney disease. The patients were selected from an open registry, the Campania-Salute Network, collecting information from general practitioners and community hospitals, in the Campania Region, Southern Italy, networked with the Hypertension Center of Federico II University Hospital in Naples. The end-point of the present analysis was the detection of first episode of AF by ECG or hospital admission, at any point throughout follow-up (median 36months [IQR=10-74]). During follow-up, AF developed in 117 patients. Baseline older age, greater left atrial diameter (LAd), left ventricular mass (LVM), and intimal medial thickness (IMT) were independent predictors of AF (all p<0.0001), with no effect of CV risk factors. Beta-blockers and diuretics increased risk of incident AF; use of medications inhibiting renin-angiotensin system (RAS) reduced risk by 50% (all p<0.002).

CONCLUSIONS

Older age, increased LAd, and markers of target organ damage (increased LVM and IMT), identify the hypertensive phenotype at highest risk for AF. CV risk factors do not exhibit significant, independent association. Patients on anti-RAS therapy are exposed to lower risk of incident AF.