Brachial Flow-Mediated Dilation and Incident Atrial Fibrillation The Multi-Ethnic Study of Atherosclerosis
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Date
2014
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Authors
O'Neal, Wesley T.
Efird, Jimmy T.
Yeboah, Joseph
Nazarian, Saman
Alonso, Alvaro
Heckbert, Susan R,
Soliman, Elsayed Z.
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Abstract
Objective—It is unknown whether endothelial dysfunction precedes atrial fibrillation (AF) development. The objective of
this study was to examine the association of brachial flow-mediated dilation (FMD) with incident AF.
Approach and Results—A total of 2936 participants (mean age, 61±9.9 years; 50% women; 66% nonwhites) from the
Multi-Ethnic Study of Atherosclerosis with available ultrasound brachial FMD measurements who were free of baseline
AF were included in this analysis. Baseline (2000–2002) FMD was computed from the percentage difference (%FMD)
in brachial artery diameter and maximum diameter during measured vasodilator response. AF was ascertained from
hospitalization data including Medicare claims during a median follow-up of 8.5 years. Probability-weighted Cox
proportional-hazards regression was used to compute hazard ratios and 95% confidence intervals for the association
between FMD as a continuous variable (%FMD values per 1-SD increase) and incident AF. Incident AF was detected in
137 (4.7%) participants. Those with %FMD values below the sex-specific median value (median %FMD; men, 3.6%;
women, 4.2%; incidence rate per 1000 person-years, 7.3; 95% confidence interval, 5.9–9.0) were more likely to develop
AF than people whose %FMD values were above the median value (incidence rate per 1000 person-years, 4.5; 95%
confidence interval, 3.4–5.8; log-rank P=0.0043). In a multivariable Cox regression analysis, each 1-SD increase in
%FMD values (SD, 2.8%) was associated with less incident AF (hazard ratio, 0.84; 95% confidence interval, 0.70–0.99).
These results were consistent across subgroups stratified by age, sex, and race/ethnicity.
Conclusions—Smaller brachial FMD values are associated with higher rates of AF, sugges
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DOI
10.1161/ATVBAHA.114.304560