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Etiology distribution of patients with
atrial fibrilation by echocardiography:
results from a prospective study in 3755
adults
Enes Abdovic
Cantonal Hospital Zenica, Zenica, Bosnia and
Herzegovina
Purpose
Purpose
• Atrial fibrillation (AF) is the most prevalent sustained
cardiac arrhythmia 1
• It is a disease of the elderly and it is common in
patients with structural heart disease1
• Hypertension (HA), diabetes mellitus, myocardial
infarction, heart failure (with impaired or preserved
left ventricular systolic function), and valvular heart
disease are recognized predisposing factors to AF2,3,4
• Objectives: To evaluate predisposing factors for
development of AF in our hospital settings
1Go
AS, et al. JAMA 2001;285:2370–75.
A, et al. Curr Pharm Des 2007;13:2545–55.
3Grigioni F, et al. J Am Coll Cardiol 2002;40:84–92.
4Olsson LG, et al. J Am Coll Cardiol 2006;47:1997–2004.
2Aidietis
Methods Methods
• From June 2000 to February 2013, 3755 consecutive patients
with AF were studied during echocardiographic check-up
• According to transthoracic echo, patients were divided in
groups based on dominative underlying heart diseases
• Electrocardiographically documented AF was subdivided in
two groups: transitory and chronic
– Transitory AF fulfilled criteria for paroxysmal or persistent AF1
– Chronic AF were cases of long-standing persistent or permanent AF1
• Binary logistic regression was used to investigate
relationship of gender, age, hypertension, diabetes and
underlying heart diseases with the type of AF
Camm AJ, et al. Eur Heart J 2010;31:2369–2429.
Results
• The median age was 72 years, age range
between 16 and 96 years
• There were 51.4% of females.
• Chronic AF was observed in 68.3% pts.
• Lone AF was diagnosed in only 25 patients,
mostly in younger males (median age 48 years,
range 29–59, men 80%)
Etiological distribution AF
by echocardiography (3755 pts)
HHD=hypertensive heart disease; DCM=dilated cardiomyopathy; CAD=coronary artery
disease; VHD=valvular heart disease; Lone=lone AF; HF=heart failure; AF=atrial fibrillation.
Comorbidities associated with AF
HHD
DCM
CAD
VHD
Lone
OTHER
TOTAL
No of pts (%)
1511 (40.2)
935 (24.9)
522 (13.9)
416 (11.1)
25 (0.7)
346 (9.2)
3755 (100)
Females (%)
850 (56.3)
394 (42.1)
224 (42.9)
251 (60.3)
5 (20.0)
207 (59.8)
1931 (51.4)
Age, median (yrs)
71
72
72
68
48
69
72
Age, range (yrs)
24-96
32-95
41-96
33-93
29-60
16-92
16-96
BMI [kg/m2]
29.4
26.9
28.4
27
26.4
28.1
28.2±5
Transitory AF (%)
543 (35.9)
200 (21.4)
220 (42.2)
84 (20.2)
18 (72.0)
126 (36.4)
1191 (31.7)
Hypertension (%)
1511 (100)
624 (66.7)
348 (66.7)
198 (47.6)
0
172 (49.7)
2832 (75.4)
Diabetes (%)
300 (19.9)
168 (18.0)
158 (30.3)
37 (8.9)
0
41 (11.9)
706 (18.8)
Thyreoid disease (%)
0 (0)
51 (5.5)
27 (5.2)
18 (4.3)
0
181 (52.3)
240 (6.4)
No=number; pts=patients; AF=atrial fibrillation; BMI=body mass index; HHD=hypertensive heart disease;
DCM=dilated cardiomyopathy; CAD=coronary artery disease; VHD=valvular heart disease; Lone=lone AF.
Comorbidities associated with AF
HHD
DCM
CAD
VHD
Lone
OTHER
TOTAL
No of pts (%)
1511 (40.2)
935 (24.9)
522 (13.9)
416 (11.1)
25 (0.7)
346 (9.2)
3755 (100)
Females (%)
850 (56.3)
394 (42.1)
224 (42.9)
251 (60.3)
5 (20.0)
207 (59.8)
1931 (51.4)
Age, median (yrs)
71
72
72
68
48
69
72
Age, range (yrs)
24-96
32-95
41-96
33-93
29-60
16-92
16-96
BMI [kg/m2]
29.4
26.9
28.4
27
26.4
28.1
28.2±5
Transitory AF (%)
543 (35.9)
200 (21.4)
220 (42.2)
84 (20.2)
18 (72.0)
126 (36.4)
1191 (31.7)
Hypertension (%)
1511 (100)
624 (66.7)
348 (66.7)
198 (47.6)
0
172 (49.7)
2832 (75.4)
LBBB(%)
95 (24.7)
209 (54.4)
36 (9.4)
19 (5.0)
0
25 (6.5)
384 (10.2)
Galstones (%)
263 (45.7)
131 (22.8)
84 (14.6)
51 (8.9)
0
45 (7.8)
575 (15.3)
No=number; pts=patients; AF=atrial fibrillation; BMI=body mass index; HHD=hypertensive heart disease;
DCM=dilated cardiomyopathy; CAD=coronary artery disease; VHD=valvular heart disease; Lone=lone AF.
AF and HA pts (2854=76%)
HHD=hypertensive heart disease; DCM=dilated cardiomyopathy; CAD=coronary artery
disease; VHD=valvular heart disease; Lone=lone AF; HF=heart failure; AF=atrial fibrillation.
AF and HF pts (1832=49%)
HHD=hypertensive heart disease; DCM=dilated cardiomyopathy; CAD=coronary artery
disease; VHD=valvular heart disease; Lone=lone AF; HF=heart failure; AF=atrial fibrillation.
Characteristics of patients with chronic vs. transitory AF
AF, type
Chronic AF
Transitory AF
Total
No pts (%)
2564 (68.3)
1191 (31.7)
3755 (100%)
Females (%)
1306 (50.9)
625 (52.5)
1931 (51.4)
Age,means&SD,yrs (range)
70±10 (16-96)
68±11 (24-94)
71±10 (16-96)
BMI [kg/m2]
28.4
27.9
28.2
Hypertension (%)
1891 (73.8)
941 (79.0)
2832 (75.4)
Diabetes (%)
430 (16.8)
191 (16.0)
706 (18.8)
Coronary artery dysease (%)
594 (23.2)
347 (29.1)
941 (25.1)
Gallstones (%)
366 (14.3)
203 (17.1)
569 (15.3)
LBBB (%)
259 (10.1)
124 (10.4)
383 (10.2)
Stroke/TIA (%)
241 (9.4)
67 (5.6)
308 (8.2)
Thyroid dysfunction (%)
156 (6.1)
84 (7.1)
240 (6.4)
No=number; pts=patients; AF=atrial fibrillation; SD=standard deviation, yrs=years,
BMI=body mass index; LBBB=left bundle branch block; TIA=transitory ischemic attack.
Results (2)Results (2)
• Hypertensive heart disease (HHD) was the most
common underlying heart disease (40.2%)
followed by dilated cardiomyopathy (DCM),
24.9%, coronary artery disease (CAD), 13.9%
and valvular heart disease (VHD), 11.1%.
• Thyroid gland disease was found in 240:6.3% of
patients of which 52.9% was hypothyroidism
(127 vs 113)
Results (3)Results (2)
• Hypertension, diabetes and thyroid gland
disease were found in 75.4%, 18.8% and 6.3%
patients, respectively,
mostly in females:
• (HA: 1556pts/2832=55.0%)
• (DM: 453pts/706=64.2%)
• (Thy.gl.disease: 193pts/240=80.4%)
Risk of chronic atrial fibrillation (binary logistic regression model)
HHD, hypertensive heart disease; DCM, dilated cardiomyopathy;
CHD, coronary artery disease; VHD, valvular heart disease; Lone,
lone atrial fibrillation; BMI, body mass index; HA, hypertension;
DM, diabetes mellitus; TH, diseases of thyroid gland; IVB,
intraventricular block.
Pts with/without Paroxismal AF
Aged ≥65yrs and/or with
LAE ≥ 25 and/or with IAB
Group
1
2
N=3985 N=1783
3
N=396
4
N=400
5
N=472
6
N=403
7
N=172
8
N=154
Age≥65
-
+
-
-
+
+
-
+
IAB
-
-
+
-
+
-
+
+
LAE
-
-
-
+
-
+
+
+
AF/NO
2883
1619
359
354
392
368
89
143
AF/YES
129
136
30
35
61
59
40
54
AF(%)
3.2
7.6
7.6
8.8
12.9
14.7
23.3
35.1
CHA2DS2-VASc score ≥ 2 = 86.5%
HHD
DCM
CAD
VHD
Other
Age
Female
(%)
Total
3777
0
-
-
11
36
40
53 ± 9
-
106
1
158
41
52
92
57
58 ± 9
72 (17.8)
405
2
342
119
108
90
97
66 ± 9
256 (33.8)
757
3
457
242
146
110
78
72 ± 7
518 (50.2)
1033
4
365
282
106
54
55
75 ± 6
600 (69.6)
862
5
153
158
72
25
16
75 ± 6
337 (79.5)
424
6
40
72
27
8
3
77 ± 5
119 (79.3)
150
7
8
17
3
-
-
77 ± 3
27 (96.4)
28
8
-
4
5
1
-
77 ± 3
10 (100.0)
10
9
-
2
-
-
-
80 ± 0
2 (100.0)
2
ConclusionConclusion
• Hypertension was by far the most prevalent
associated medical condition in patients with AF
• AF without underlying heart disease was present in
only 0.7%, mostly in younger patients, males, with
transitory AF
• Almost 1/2 of pts with AF had HF and 59.2% had
diastolic HF.
• Chronic AF was predominant in groups with
advanced cardiac remodeling such as DCM and
VHD, mostly in elderly
Take HomeConclusion
Message
• Optimal treatement of HA as well as
DM
• to prevent CAD and HF and
• to eliminate or at least postpone AF,
the most common sustained cardiac
arrhythmia