Identification of clinical risk factors of atrial fibrillation in congestive heart failure

Abstract

Background: Factors associated with the development of atrial fibrillation (AF) in general
population have been described, but it is still unknown whether the same risk factors apply
to heart failure (HF) patients. The aim of this study was to identify clinical factors related to
various forms of AF in HF patients.

Methods: The clinical and echocardiographic characteristics were assessed in 155 HF patients:
50 with sinus rhythm, 52 with non-permanent AF, and 53 with permanent AF.

Results: Multivariate logistic regression analysis showed that the increase in the NYHA
class was an independent risk factor for both forms of AF. The occurrence of permanent AF in
comparison to sinus rhythm group was independently associated with hs-C-reactive protein
(CRP) elevation above 1 mg/dL (OR 1.87, 95% CI 1.05–3.35), left atrial dimension above
4 cm (OR 3.78, 95% CI 1.29–11.06) and tricuspid maximal pressure gradient elevation above
35 mm Hg (OR 5.01, 95% CI 1.38–18.27). The presence of coronary disease was independently
associated with less frequent occurrence of permanent AF in comparison to sinus rhythm group
(OR 0.21, 95% CI 0.06–0.67).

Conclusions: More advanced congestive HF was associated with presence of both types of AF.
Non-ischemic etiology of HF and elevated CRP are independently associated with permanent
AF compared to sinus rhythm. Left ventricular diastolic dysfunction indicators (increased
tricuspid maximal pressure gradient and left artial dimension) are independently associated
with permanent AF.