Open AccessThe clinical utility of normal findings on noninvasive cardiac assessment in the prediction of atrial fibrillation
Author(s) -
Venkatesh Sanjay,
O'Neal Wesley T.,
Broughton Stephen T.,
Shah Amit J.,
Soliman Elsayed Z.
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22644
Subject(s) - medicine , atrial fibrillation , cardiology , hazard ratio , confidence interval , proportional hazards model , premature atrial contraction
Background The absence of abnormalities on noninvasive cardiac assessment possibly confers a reduced risk of atrial fibrillation (AF) despite the presence of traditional risk factors. Hypothesis Normal findings on noninvasive cardiac assessment are associated with a lower risk of AF development. Methods We examined the clinical utility of normal findings on routine noninvasive cardiac assessment in 5331 participants (85% white; 57% women) from the Cardiovascular Health Study who were free of baseline AF . The combination of a normal electrocardiogram ( ECG ) + normal echocardiogram was assessed for the development of AF events. A normal ECG was defined as the absence of major or minor Minnesota code abnormalities. A normal echocardiogram was defined as the absence of contractile dysfunction, wall motion abnormalities, or abnormal left ventricular mass. Cox regression was used to compute the 10‐year risk of developing AF . Results During the 10‐year study period, a total of 951 (18%) AF events were detected. A normal ECG (multivariable hazard ratio [ HR ]: 0.80, 95% confidence interval [ CI ]: 0.69‐0.92) and normal echocardiogram (multivariable HR : 0.75, 95% CI : 0.65‐0.87) were associated with a reduced risk of AF in isolation. This association improved in those with normal ECG + normal echocardiogram (multivariable HR : 0.66, 95% CI : 0.55‐0.79) compared with participants who had abnormal ECG + abnormal echocardiogram (referent). Conclusions Normal findings on routine noninvasive cardiac assessment identify persons in whom the risk of AF is low. Further studies are needed to explore the utility of this profile regarding the decision to implement certain risk factor modification strategies in older adults to reduce AF burden.