Abstract
Objective
To evaluate the relationship between peripheral arterial disease (PAD) and incident
atrial fibrillation (AF) and its clinical and pathophysiologic implications on ischemic
stroke and all-cause mortality.
Patients and Methods
We identified all adult patients in the Mayo Clinic Health System without a previous
diagnosis of AF undergoing ankle-brachial index (ABI) testing for any indication from
January 1, 1996, to June 30, 2018. Retrospective extraction of ABI data and baseline
echocardiographic data was performed. The primary outcome of interest was incident
AF. The secondary outcomes of interest were incident ischemic stroke and all-cause
mortality.
Results
A total of 33,734 patients were included in the study. After adjusting for demographic
and comorbidity variables, compared with patients who had normal ABI (1.0 to 1.39),
there was an increased risk of incident AF in patients with low ABI (<1.0) (adjusted
hazard ratio, 1.14; 95% CI, 1.06 to 1.22) and elevated ABI (≥1.4) (adjusted hazard
ratio, 1.18; 95% CI, 1.06 to 1.31). The risk was greater in patients with increasing
severity of PAD. Patients with abnormal ABIs had an increased risk of ischemic stroke
and all-cause mortality. We found that patients with PAD and incident AF have certain
baseline echocardiographic abnormalities.
Conclusion
In this large cohort of ambulatory patients undergoing ABI measurement, patients with
PAD were at increased risk for incident AF, ischemic stroke, and mortality. In these
high-risk patients with abnormal ABI, particularly severe PAD and cardiac structural
abnormalities, routine monitoring for AF and management of cardiovascular risk factors
may be warranted.
Abbreviations and Acronyms:
ABI (ankle-brachial index), AF (atrial fibrillation), ARIC (Atherosclerosis Risk in Communities), HR (hazard ratio), ICD (International Classification of Diseases), IL (interleukin), IQR (interquartile range), LAVI (left atrial volume index), LVEF (left ventricular ejection fraction), LVMI (left ventricular mass index), PAD (peripheral arterial disease), RVSP (right ventricular systolic pressure)To read this article in full you will need to make a payment
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Article Info
Footnotes
Potential Competing Interests: The authors report no competing interests.
Identification
Copyright
© 2020 Mayo Foundation for Medical Education and Research
