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Published on: February 26, 2013
Concealed Coronary Atherosclerosis In Idiopathic Paroxysmal Atrial Fibrillation is Associated with Imminent
Eamp Dudink1, B Weijs1, Jglm Luermans1
1Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
Insights
Subclinical coronary artery disease (CAD) identified on cardiac CT angiography in patients with idiopathic atrial fibrillation (iAF) does not predict future cardiovascular events. However, CTA findings can identify high-risk iAF patients needing closer monitoring.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Previous studies indicated differences in subclinical coronary artery disease (CAD) on cardiac CT angiography (CTA) between patients with idiopathic paroxysmal atrial fibrillation (iAF) and those in sinus rhythm (iSR).
- This study presents 5-year follow-up data to evaluate the impact of baseline subclinical CAD on CTA for cardiovascular disease development in iAF patients.
Purpose of the Study:
- To assess the long-term cardiovascular outcomes in patients with idiopathic paroxysmal atrial fibrillation (iAF) compared to a matched sinus rhythm population (iSR).
- To identify predictors of incident cardiovascular disease within the iAF group, specifically focusing on baseline cardiac CT angiography findings.
Main Methods:
- A cohort of 99 iAF patients and 221 matched iSR controls underwent cardiac CT angiography (CTA).
- Follow-up data on hypertension, diabetes, and major adverse cardiovascular and cerebrovascular events (MACCE) were collected.
- Multivariable Cox regression analysis was employed to determine predictors of cardiovascular disease in the iAF group.
Main Results:
- Over a median follow-up of 68 months, approximately one-third of patients developed cardiovascular disease, with no significant difference between iAF and iSR groups (p=0.56).
- Major adverse cardiovascular and cerebrovascular events (MACCE) rates were comparable between the groups (4.0% vs 5.0%, p=0.71).
- In iAF patients, age, left atrial diameter, Segment Involvement Score, and the number of calcified plaques on CTA independently predicted incident cardiovascular disease.
Conclusions:
- Subclinical coronary artery disease (CAD) detected by CTA in idiopathic paroxysmal atrial fibrillation (iAF) patients did not predict future cardiovascular events or MACCE.
- CTA findings, including Segment Involvement Score and calcified plaques, can identify iAF patients with concealed cardiovascular risk factors.
- Intensive clinical follow-up and timely initiation of prophylactic therapies are crucial for iAF patients identified as high-risk based on CTA findings.
Background:
Previous research showed a significant difference in the presence of subclinical coronary artery disease (CAD) on cardiac CT angiography (CTA) between patients with idiopathic paroxysmal atrial fibrillation (iAF) versus a matched sinus rhythm population (iSR). Here we present 5-year follow-up data and the consequences of subclinical CAD on baseline CTA on the development of cardiovascular disease in iAF.
Methods:
In 99 iAF patients (who underwent CTA as part of work-up for pulmonary vein isolation) and 221 matched iSR controls (who underwent CTA for CAD assessment), the incidence of hypertension, diabetes and major cardiovascular events (MACCE) during follow-up was obtained. Multivariable Cox regression analysis was used to reveal predictors of incident cardiovascular disease in the iAF group.
Results:
During a follow-up of 68±11 months, over one third of patients developed cardiovascular disease, with no difference between iAF and iSR (log-rank p=0.56), and comparable low rates of MACCE (4.0% vs 5.0%,p=0.71). Within the iAF group, age (HR1.12(1.03-1.20);p=0.006), left atrial diameter (HR1.16(1.03-1.31);p=0.01), Segment Involvement Score (total number of coronary segments with atherosclerotic plaque; HR1.43(1.09-1.89);p=0.01) and the number of calcified plaques on CTA (HR0.53(0.30-0.92);p=0.01) were independent predictors of incident cardiovascular disease.
Conclusions:
Subclinical coronary disease on CTA may be useful to identify the subset of patients with iAF that harbour concealed cardiovascular risk factors and need intensive clinical follow-up to ensure timely initiation of appropriate therapy once CV disease develops, including anticoagulation and vascular prophylactic therapy.
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