부산대학교 도서관

Introduction: The prospective, multicenter REVEAL AF trial assessed the incidence of "subclinical/silent" atrial fibrillation (AF) detectable by insertable cardiac monitors (ICM) in patients with no prior known AF. Enrolled were 446 patients with CHADS2 scores ≥3 or =2 plus ≥1 additional risk factor (sleep apnea, coronary artery disease, renal impairment or COPD). A 12-single nucleotide polymorphism genetic risk score (AF-GRS) has been previously reported to predict clinically manifest AF. Hypothesis: We investigated whether the AF-GRS was associated with incident AF identified by ICM during 18-30 months of follow up in REVEAL AF. Methods: The 234 patients who consented to genetic studies were included in this sub-study. We used Cox models that adjusted for potential confounders to assess the association between AF-GRS and incident AF. Median follow up was 25 months. Patients were categorized into AF-GRS quintiles derived from a previous population-based analysis, with group 1 representing the lowest quintile and group 5 the highest. Results: AF detection rate at 12 months was 38.9% (95% CI 26.5 - 54.5%) in the highest AF-GRS group (group 5) vs. 24.7% (95% CI 19.1 - 31.7%) in groups 1-4. After adjusting for age, sex and body mass index (each an established predictor of AF), patients with the highest AF-GRS were at greatest risk of incident AF: HR 1.8 (95% CI 1.0 - 3.3) for group 5 patients compared with group 1 patients (p<0.05). Additionally, the HR was 2.1 (95% CI 1.2 - 3.4) for group 5 patients compared with those in groups 1-4 combined (p=0.005). Conclusion: Among patients at high demographic risk for AF but without known AF, a high AF-GRS identified a subset of patients at ~2-fold increased risk for AF compared to those with lower AF-GRS. A high AF-GRS may serve as an additional marker to identify patients most likely to exhibit AF during extended ICM monitoring. [ABSTRACT FROM AUTHOR]