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Association between diastolic dysfunction and future atrial fibrillation in the Tromsø Study from 1994 to 2010
  1. Sweta Tiwari1,
  2. Henrik Schirmer2,3,
  3. Bjarne K Jacobsen1,
  4. Laila A Hopstock1,
  5. Audhild Nyrnes1,
  6. Geir Heggelund2,
  7. Inger Njølstad1,
  8. Ellisiv B Mathiesen2,4,
  9. Maja-Lisa Løchen1
  1. 1Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
  2. 2Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
  3. 3Department of Cardiology, The University Hospital of North Norway, Tromsø, Norway
  4. 4Department of Neurology and Neurophysiology, The University Hospital of North Norway, Tromsø, Norway
  1. Correspondence to Sweta Tiwari, Department of Community Medicine, UiT The Arctic University of Norway, N-9037 Tromsø, Norway; sweta.tiwari{at}


Objective To investigate the association between echocardiographic measurements with emphasis on diastolic dysfunction and risk of atrial fibrillation (AF) in a population-based cohort study.

Methods We followed 2406 participants from the Tromsø Study from 1994 to 2010. Left atrial (LA) size and mitral Doppler indices as measured by echocardiography were used for evaluating diastolic dysfunction. Information concerning age, systolic blood pressure, height, heart rate, body mass index, total and high-density lipoprotein cholesterol, self-reported use of alcohol, smoking, coffee, physical activity, antihypertensive treatment, prevalent coronary heart disease, valvular heart disease, heart failure, hypertrophy, diabetes and palpitations were obtained at baseline. The outcome measure was clinical AF, documented by an ECG.

Results AF was detected in 462 subjects (193 women). Mean age at baseline was 62.6 years. Incidence rate of clinical AF was 12.6 per 1000 person-years. In multivariable Cox proportional hazards regression analysis, moderately enlarged LA was associated with 60% (95% CI 1.2 to 2.0) increased risk of AF. Severely enlarged LA had HR for AF of 4.2 (95% CI 2.7 to 6.5) with p value for linear trend <0.001, and the association was similar in both sexes. Abnormal mitral Doppler flow adjusted for predictor variables did not show a statistically significant association with AF risk. However, when LA size was also adjusted for, the risk of AF increased by 30% (95% CI 1.0 to 1.6).

Conclusions Our findings suggest that enlarged LA as a measure for diastolic dysfunction is a significant risk factor for AF in both sexes, and adding measures of abnormal diastolic flow increased the predictive ability significantly.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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