Background
Methods
Study population and design
Data collection
Laboratory measurements
Follow-up and outcomes
Statistical analysis
Results
Total population n = 433 | Individuals with VHDs | Individuals without VHDs n = 283 | P value | ||
---|---|---|---|---|---|
ERHA Type 1 n = 91 | ERHA Type 2 n = 59 | ||||
Male, n (%) | 221 (51.0) | 29 (31.9) | 30 (50.8) | 162 (57.2) | < 0.001 |
Age, years (SD) | 65.6 (13.2) | 58.0 (11.1) | 62.9 (16.0) | 65.5 (12.7) | < 0.001 |
BMI, kg/m2(SD) | 24.2 (3.8) | 22.8 (3.4) | 22.8 (3.6) | 24.8 (3.7) | < 0.001 |
SBP, mmHg (SD) | 122.8 (22.3) | 117.3 (20.3) | 123.2 (23.5) | 124.5 (22.4) | 0.025 |
Heart rate, beats/min (SD) | 102.5 (29.9) | 100.5 (29.4) | 97.9 (29.0) | 104.1 (30.2) | 0.273 |
Duration of AF | < 0.001 | ||||
Paroxysmal, n (%) | 79 (18.2) | 11 (12.1) | 15 (25.4) | 53 (18.7) | |
Persistent, n (%) | 177 (40.9) | 21 (23.1) | 6 (10.2) | 150 (53.0) | |
Permanent, n (%) | 177 (40.9) | 59 (64.8) | 38 (64.4) | 80 (28.3) | |
Smoking, n (%) | 112 (25.9) | 12 (13.2) | 16 (27.1) | 84 (29.7) | 0.007 |
Alcohol, n (%) | 36 (8.3) | 4 (4.4) | 6 (10.2) | 26 (9.2) | 0.304 |
Hypertension, n (%) | 224 (51.7) | 23 (25.3) | 31 (52.5) | 170 (60.1) | < 0.001 |
Diabetes, n (%) | 171 (39.5) | 31 (34.1) | 28 (47.5) | 112 (39.6) | 0.261 |
Hypercholesterolemia, n (%) | 22 (5.1) | 0 (0) | 7 (11.9) | 15 (5.3) | 0.005 |
TIA or Stroke, n (%) | 61 (14.1) | 11 (12.1) | 7 (11.9) | 43 (15.2) | 0.661 |
CADs, n (%) | 107 (24.7) | 5 (5.5) | 11 (18.6) | 91 (32.2) | < 0.001 |
Heart failure, n (%) | 243 (56.3) | 74 (81.3) | 51 (86.4) | 118 (41.7) | < 0.001 |
CHA2DS2-VASc Score | |||||
Mean (SD) | – | – | 3.4 (1.6) | 3.1 (1.8) | – |
Median (IQR) | – | – | 3 (2–4) | 3 (2–4) | – |
≥ 2(Male) or ≥ 3(female), n (%) | – | – | 49 (83.1) | 211 (74.6) | – |
ALT, u/l (IQR) | 19 (14.0–31.3) | 18 (14–27) | 23 (15–40) | 19 (14–32) | 0.223 |
eGFR, ml/(min·1.73 m2) | 70.1 (26.9) | 73.2 (25.1) | 64.9 (27.1) | 70.1 (27.4) | 0.197 |
eGFR < 60 ml/(min·1.73 m2), n (%) | 154 (35.6) | 28 (30.8) | 28 (47.5) | 98 (34.6) | 0.309 |
Warfarin, n (%) | 119 (27.5) | 55 (60.4) | 23 (39.0) | 41 (14.5) | < 0.001 |
INR, mean (SD)a | 1.91 (0.77) | 2.16 (0.76) | 1.83 (0.75) | 1.51 (0.62) | < 0.001 |
TiTR ≥ 66%, n (%)a | 27 (22.7) | 21 (38.2) | 5 (21.7) | 2 (4.9) | < 0.001 |
Antiplatelet agents, n (%) | 214 (49.4) | 25 (27.5) | 23 (39.0) | 166 (58.7) | < 0.001 |
Beta blockers, n (%) | 266 (61.4) | 48 (52.7) | 38 (64.4) | 180 (63.6) | 0.159 |
ACEIs/ARBs, n (%) | 146 (33.7) | 19 (20.9) | 22 (37.3) | 105 (37.1) | 0.014 |
CCBs, n (%) | 87 (20.1) | 6 (6.6) | 11 (18.6) | 70 (24.7) | 0.001 |
Outcomes | Total population n = 433 | Individuals with VHDs | Individuals without VHDs n = 283 | P-value | |
---|---|---|---|---|---|
ERHA Type 1 n = 91 | ERHA Type 2 n = 59 | ||||
Death, n (%) | 73 (16.9) | 19 (20.9) | 10 (16.9) | 44 (15.5) | 0.497 |
Heart failure, n (%) | 24 (5.5) | 1 (1.1) | 7 (11.9) | 16 (5.7) | 0.019 |
ACS, n (%) | 6 (1.4) | 1 (1.1) | 0 (0) | 5 (1.8) | 0.375 |
Hypotension, n (%) | 3 (0.7) | 0 (0) | 0 (0) | 3 (1.1) | 0.278 |
TIA or Stroke, n (%) | 39 (9.0) | 6 (6.6) | 1 (1.7) | 32 (11.3) | 0.042 |
VT or VF, n (%) | 2 (0.5) | 1 (1.1) | 0 (0) | 1 (0.4) | 0.395 |
Othersa , n (%) | 2 (0.5) | 0 (0) | 1 (1.7) | 1 (0.4) | 0.605 |
HR represents | Total population n = 433 | EHRA Type 1 n = 91 | ERHA Type 2 n = 59 | Patients without VHDs n = 283 | |
---|---|---|---|---|---|
Male | Versus female | 2.182 (1.332–3.576), 0.002 | 1.761 (0.708–4.384), 0.224 | 1.999 (0.516–7.745), 0.316 | 3.086 (1.483–6.421), 0.003 |
Age | Per 1-year increment | 1.024 (1.004–1.045), 0.017 | 1.052 (1.007–1.100), 0.024 | 1.029 (0.982–1.078),0.229 | 1.018 (0.991–1.045), 0.189 |
BMI (kg/m2) | Per 1 kg/m2 increment | 0.908 (0.848–0.973), 0.006 | 0.812 (0.693–0.952), 0.010 | 0.899 (0.730–1.108),0.319 | 0.957 (0.878–1.043), 0.317 |
Systolic blood pressure | Per 1 mmHg increment | 0.989 (0.978–1.001), 0.073 | 0.987 (0.964–1.010), 0.274 | 0.993 (0.965–1.022), 0.653 | 0.990 (0.975–1.005),0.202 |
Heart rate | Per 1 bpm increment | 0.990 (0.982–0.998), 0.016 | 0.987 (0.970–1.004), 0.139 | 0.992 (0.969–1.016), 0.513 | 0.992 (0.982–1.002), 0.110 |
Duration of AF | |||||
Persistent | Versus Paroxysmal | 0.781 (0.365–1.670), 0.524 | 1.743 (0.181–16.767), 0.630 | 3.024 (0.424–21.541),0.269 | 0.650 (0.264–1.597), 0.347 |
Permanent | Versus Paroxysmal | 2.128 (1.068–4.237), 0.032 | 3.409 (0.450–25.818), 0.235 | 1.348 (0.272–6.688),0.714 | 2.492 (1.061–5.851), 0.036 |
Smoking | Yes versus no | 1.844 (1.149–2.960), 0.011 | 1.136 (0.331–3.898), 0.840 | 1.655 (0.466–5.878), 0.436 | 2.439 (1.336–4.415), 0.004 |
Hypertension | Yes versus no | 0.729 (0.459–1.158), 0.181 | 0.994 (0.230–2.092), 0.516 | 0.995 (0.288–3.440),0.993 | 0.736 (0.407–1.331), 0.311 |
Diabetes | Yes versus no | 1.200 (0.754–1.910), 0.442 | 1.368 (0.550–3.402), 0.500 | 0.411 (0.106–1.591),0.198 | 1.447 (0.798–2.623), 0.224 |
Hypercholesterolemia | Yes versus no | 1.426 (0.348–5.851), 0.622 | NA | 1.584 (0.199–12.609),0.664 | 1.246 (0.169–9.181), 0.829 |
TIA or stroke | Yes versus no | 1.181 (0.621–2.244), 0.612 | 1.725 (0.502–5.937), 0.387 | 1.430 (0.179–11.388),0.736 | 1.072 (0.477–2.410), 0.866 |
CADs | Yes versus no | 1.485 (0.900–2.451), 0.122 | 0.044 (0.000–91.652), 0.424 | 0.419 (0.053–3.309),0.409 | 2.537 (1.392–4.622), 0.002 |
Heart failure | Yes versus no | 3.393 (1.967–5.853), < 0.001 | 2.422 (0.559–10.503), 0.237 | NA | 3.872 (2.059–7.283), < 0.001 |
CHA2DS2-VASc Score | Per 1 score increment | NA | NA | 1.000 (0.656–1.525),0.999 | 1.159 (0.986–1.363), 0.074 |
ALT | Per 1 U/l increment | 1.002 (1.001–1.004), < 0.001 | 1.001 (0.998–1.004), 0.506 | 0.917 (0.839–1.002), 0.056 | 1.003 (1.001–1.004), < 0.001 |
eGFR | Per 1 ml/(min·1.73 m2) increment | 0.982 (0.971–0.993), 0.001 | 0.990 (0.970–1.009), 0.292 | 0.993 (0.965–1.022), 0.634 | 0.974 (0.959–0.990), 0.001 |
Warfarin | Yes versus no | 1.065 (0.637–1.781), 0.811 | 0.680 (0.276–1.675),0.402 | 1.054 (0.297–3.736), 0.935 | 1.098 (0.464–2.600), 0.832 |
TiTR | ≥ 66% versus < 66% | 0.551 (0.173–1.750), 0.312 | 0.533 (0.155–1.830), 0.317 | NA | NA |
Variable | HR represents | HR (95%CI) | P value |
---|---|---|---|
Total population | |||
Age | Per 1-year increment | 1.018 (0.999–1.038) | 0.066 |
Male | Versus female | 2.418 (1.445–4.046) | 0.001 |
Duration of AF | < 0.001 | ||
Persistent | Versus paroxysmal | 0.781 (0.352–1.737) | 0.545 |
Permanent | Versus paroxysmal | 2.379 (1.156–4.896) | 0.019 |
Warfarin | Yes versus no | 1.200 (0.661–2.179) | 0.548 |
TiTR | ≥ 66% versus < 66% | 0.571 (0.137–1.656) | 0.243 |
eGFR | Per 1 ml/(min·1.73 m2) increment | 0.984 (0.972–0.995) | 0.006 |
Individuals with EHRA Type 1 VHDs | |||
Age | Per 1-year increment | 1.044 (0.997–1.092) | 0.067 |
Male | Versus female | 1.817 (0.687–4.808) | 0.229 |
Duration of AF | 0.277 | ||
Persistent | Versus paroxysmal | 1.994 (0.196–20.257) | 0.560 |
Permanent | Versus paroxysmal | 3.937 (0.496–31.278) | 0.195 |
TiTR | ≥ 66% versus < 66% | 0.491 (0.124–1.945) | 0.311 |
Warfarin | Yes versus no | 0.949 (0.334–2.700) | 0.922 |
eGFR | Per 1 ml/(min·1.73 m2) increment | 0.988 (0.967–1.010) | 0.281 |
Individuals with EHRA Type 2 VHDs | |||
Age | Per 1-year increment | 1.003 (0.976–1.093) | 0.269 |
Male | Versus female | 1.439 (0.323–6.413) | 0.633 |
Duration of AF | 0.145 | ||
Persistent | Versus paroxysmal | 33.672 (1.001–1132.496) | 0.050 |
Permanent | Versus paroxysmal | 7.210 (0.544–95.538) | 0.134 |
CHA2DS2-VASc score | Per 1 score increment | 0.482 (0.214–1.089) | 0.079 |
Warfarin | Yes versus no | 1.122 (0.196–6.422) | 0.897 |
eGFR | Per 1 ml/(min·1.73 m2) increment | 1.000 (0.965–1.037) | 0.985 |
Individuals without VHDs | |||
Age | Per 1-year increment | 0.991 (0.961–1.022) | 0.568 |
Male | Versus female | 3.936 (1.780–8.706) | 0.001 |
Duration of AF | 0.003 | ||
Persistent | Versus paroxysmal | 0.561 (0.223–1.412) | 0.220 |
Permanent | Versus paroxysmal | 1.866 (0.769–4.528) | 0.168 |
CHA2DS2-VASc score | Per 1 score increment | 1.136 (0.927–1.392) | 0.217 |
Warfarin | Yes versus no | 1.270 (0.528–3.053) | 0.594 |
eGFR | Per 1 ml/(min·1.73 m2) increment | 0.975 (0.959–0.992) | 0.003 |
Variable | HR represents | HR (95%CI) | P value |
---|---|---|---|
Total population | |||
Age | Per 1-year increment | 1.018 (0.999–1.038) | 0.063 |
Male | Versus female | 2.441 (1.475–4.040) | 0.001 |
Duration of AF | < 0.001 | ||
Persistent | Versus paroxysmal | 0.747 (0.347–1.608) | 0.455 |
Permanent | Versus paroxysmal | 2.187 (1.095–4.370) | 0.027 |
Warfarin | Yes versus no | 1.329 (0.753–2.348) | 0.326 |
TiTR | ≥ 66% versus < 66% | 0.420 (0.122–1.443) | 0.168 |
eGFR | 0.001 | ||
60–89 ml/(min·1.73 m2) | Versus ≥ 90 ml/(min·1.73 m2) | 1.304 (0.618–2.750) | 0.485 |
< 60 ml/(min·1.73 m2) | Versus ≥ 90 ml/(min·1.73 m2) | 2.969 (1.447–6.093) | 0.003 |
Individuals with EHRA Type 1 VHDs | |||
Age | Per 1-year increment | 1.044 (0.996–1.095) | 0.074 |
Male | Versus female | 1.912 (0.692–5.284) | 0.212 |
Duration of AF | 0.367 | ||
Persistent | Versus paroxysmal | 2.006 (0.202–19.970) | 0.553 |
Permanent | Versus paroxysmal | 3.525 (0.450–27.638) | 0.231 |
TiTR | ≥ 66% versus < 66% | 0.452 (0.112–1.823) | 0.264 |
Warfarin | Yes versus no | 0.932 (0.326–2.660) | 0.895 |
eGFR | 0.339 | ||
60–89 ml/(min·1.73 m2) | Versus ≥ 90 ml/(min·1.73 m2) | 1.264 (0.316–5.049) | 0.740 |
< 60 ml/(min·1.73 m2) | Versus ≥ 90 ml/(min·1.73 m2) | 2.522 (0.587–10.843) | 0.214 |
Individuals with EHRA Type 2 VHDs | |||
Age | Per 1-year increment | 1.075 (1.004–1.151) | 0.038 |
Male | Versus female | 2.806 (0.640–12.315) | 0.171 |
Duration of AF | 0.173 | ||
Persistent | Versus paroxysmal | 13.838 (0.877–218.340) | 0.062 |
Permanent | Versus paroxysmal | 3.615 (0.583–22.423) | 0.167 |
CHA2DS2-VASc score | Per 1 score increment | 0.619 (0.328–1.168) | 0.138 |
Warfarin | Yes versus no | 2.447 (0.516–11.603) | 0.260 |
eGFR | 0.187 | ||
60–89 ml/(min·1.73 m2) | Versus ≥ 90 ml/(min·1.73 m2) | 0.517 (0.036–7.409) | 0.517 |
< 60 ml/(min·1.73 m2) | Versus ≥ 90 ml/(min·1.73 m2) | 2.265 (0.217–23.591) | 0.494 |
Individuals without VHDs | |||
Age | Per 1-year increment | 0.993 (0.963–1.023) | 0.641 |
Male | Versus female | 3.593 (1.684–7.667) | 0.001 |
Duration of AF | 0.003 | ||
Persistent | Versus paroxysmal | 0.586 (0.234–1.465) | 0.253 |
Permanent | Versus paroxysmal | 1.921 (0.784–4.707) | 0.153 |
CHA2DS2-VASc score | Per 1 score increment | 1.121 (0.915–1.374) | 0.271 |
Warfarin | Yes versus no | 1.307 (0.542–3.151) | 0.550 |
eGFR | 0.007 | ||
60–89 ml/(min·1.73 m2) | Versus ≥ 90 ml/(min·1.73 m2) | 1.433 (0.546–3.763) | 0.465 |
< 60 ml/(min·1.73 m2) | Versus ≥ 90 ml/(min·1.73 m2) | 3.660 (1.402–9.556) | 0.008 |