Iranian Heart Journal

Iranian Heart Journal

Echocardiographic and Clinical Determinants of Atrial Fibrillation in Patients With Cardiovascular Disease: A Retrospective Study

Document Type : Original Article

Authors
Amin Esmaeilnia Shirvani 1 ΒΆ
Mahmood Moosazadeh 2
Maryam Nabati 3
1 Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, IR Iran.
2 Gastrointestinal Cancer Research Center, Noncommunicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, IR Iran.
3 Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, IR Iran.
Abstract
Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting millions of individuals worldwide. This study aimed to evaluate the epidemiological, clinical, and echocardiographic characteristics of patients with AF in a regional population.

Methods: In this retrospective study, 652 patients admitted to a tertiary cardiac center were divided into AF and non-AF groups. Demographic and clinical data were collected. Transthoracic echocardiography was performed by a cardiologist. The 2 groups were compared to establish associations and potential predictor factors for AF.

Results: Each of the 2 groups consisted of 326 patients. Significant differences were observed between the 2 groups in terms of ejection fraction (P = .001), LA enlargement (P = .001), mitral regurgitation (P = .001), tricuspid regurgitation (P = .001), and pulmonary artery hypertension (P = .001). The univariable logistic regression model revealed a significant association between AF and hypertension (OR, 1.429; 95% CI, 1.050 to 1.945; P =. 023), heart failure (OR, 1.494; 95% CI, 1.049 to 2.128; P = .026), reduced ejection fraction (OR, 2.276; 95% CI, 1.490 to 3.476; P = .001), and left atrial enlargement (OR, 3.751; 95% CI, 2.559 to 5.499; P = .001). The multivariable logistic regression model revealed a significant association between AF and hypertension (OR, 1.574; 95% CI, 1.047 to 2.367; P =.029) and left atrial enlargement (OR, 2.080; 95% CI, 1.327 to 3.261; P = .001).

Conclusions: This study revealed significant associations between atrial fibrillation and clinical and echocardiographic factors, especially hypertension and left atrial enlargement. (Iranian Heart Journal 2026; 27(4): 16-24)
Keywords
atrial fibrillation
echocardiography
arrhythmias
heart atria
1.         Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. Int J Stroke. 2021; 16(2):217-21.
2.         Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020; 76(25):2982-3021.
3.         Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014; 129(8):837-47.
4.         Babela R, Barakova A, Hatala R. Epidemiology and comprehensive economic impact of atrial fibrillation and associated stroke in Slovakia. BMC Health Serv Res. 2024; 24(1):637.
5.         Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circulation Research: Lippincott Williams and Wilkins; 2020. p. 4-20.
6.         Lehto M, Haukka J, Aro A, Halminen O, Putaala J, Linna M, et al. Comprehensive nationwide incidence and prevalence trends of atrial fibrillation in Finland. Open Heart. 2022; 9(2).
7.         Becher N, Metzner A, Toennis T, Kirchhof P, Schnabel RB. Atrial fibrillation burden: a new outcome predictor and therapeutic target. Eur Heart J. 2024; 45(31):2824-38.
8.         Karnik AA, Gopal DM, Ko D, Benjamin EJ, Helm RH. Epidemiology of Atrial Fibrillation and Heart Failure: A Growing and Important Problem. Cardiology Clinics: W.B. Saunders; 2019. p. 119-29.
9.         Shantsila E, Choi EK, Lane DA, Joung B, Lip GYH. Atrial fibrillation: comorbidities, lifestyle, and patient factors. Lancet Reg Health Eur. 2024; 37:100784.
10.      Bizhanov KA, capital A CKB, Baimbetov AK, Sarsenbayeva AB, Lyan E. Atrial fibrillation: Epidemiology, pathophysiology, and clinical complications (literature review). J Cardiovasc Electrophysiol. 2023; 34(1):153-65.
11.      Moula AI, Parrini I, Tetta C, Lucà F, Parise G, Rao CM, et al. Obstructive Sleep Apnea and Atrial Fibrillation. Journal of Clinical Medicine: MDPI; 2022.
12.      Sanchez JM, Jolly SE, Dewland TA, Tseng ZH, Nah G, Vittinghoff E, et al. Incident Atrial Fibrillation Among American Indians in California. Circulation. 2019; 140(19):1605-6.
13.      Dewland TA, Olgin JE, Vittinghoff E, Marcus GM. Incident atrial fibrillation among Asians, Hispanics, blacks, and whites. Circulation. 2013; 128(23):2470-7.
14.      Linz D, Gawalko M, Betz K, Hendriks JM, Lip GYH, Vinter N, et al. Atrial fibrillation: epidemiology, screening and digital health. Lancet Reg Health Eur. 2024; 37:100786.
15.      Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024; 149(1):e1-e156.
16.      Gabb GM, Mangoni AA, Anderson CS, Cowley D, Dowden JS, Golledge J, et al. Guideline for the diagnosis and management of hypertension in adults—2016. Medical Journal of Australia. 2016; 205(2):85-9.
17.      Petersmann A, Muller-Wieland D, Muller UA, Landgraf R, Nauck M, Freckmann G, et al. Definition, Classification and Diagnosis of Diabetes Mellitus. Exp Clin Endocrinol Diabetes. 2019; 127(S 01):S1-S7.
18.      Lipid Panel. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/lipid-panel. Accessed 24 February 2025.
19.      Kusunose K, Zheng R, Yamada H, Sata M. How to standardize the measurement of left ventricular ejection fraction. J Med Ultrason (2001). 2022; 49(1):35-43.
20.      Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010; 11(4):307-32.
21.      Jankowich M, Maron BA, Choudhary G. Mildly elevated pulmonary artery systolic pressure on echocardiography: bridging the gap in current guidelines. Lancet Respir Med. 2021; 9(10):1185-91.
22.      Keskin K, Ser OS, Dogan GM, Cetinkal G, Yildiz SS, Sigirci S, et al. Assessment of a new electrocardiographic criterion for the diagnosis of left ventricle hypertrophy: A prospective validation study. North Clin Istanb. 2020; 7(3):231-6.
23.      Otto CM. Textbook of clinical echocardiography. Philadelphia, PA: Elsevier; 2024.
24.      Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005; 18(12):1440-63.
25.      Kallistratos MS, Poulimenos LE, Manolis AJ. Atrial fibrillation and arterial hypertension. Pharmacol Res. 2018; 128:322-6.
26.      Dzeshka MS, Shantsila A, Shantsila E, Lip GYH. Atrial Fibrillation and Hypertension. Hypertension. 2017; 70(5):854-61.
27.      Verdecchia P, Angeli F, Reboldi G. Hypertension and Atrial Fibrillation: Doubts and Certainties From Basic and Clinical Studies. Circ Res. 2018; 122(2):352-68.
28.      Ariyaratnam JP, Lau DH, Sanders P, Kalman JM. Atrial Fibrillation and Heart Failure: Epidemiology, Pathophysiology, Prognosis, and Management. Card Electrophysiol Clin. 2021; 13(1):47-62.
29.      Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003; 107(23):2920-5.
30.      Tsigkas G, Apostolos A, Despotopoulos S, Vasilagkos G, Kallergis E, Leventopoulos G, et al. Heart failure and atrial fibrillation: new concepts in pathophysiology, management, and future directions. Heart Fail Rev. 2022; 27(4):1201-10.
31.      Verma A, Kalman JM, Callans DJ. Treatment of Patients With Atrial Fibrillation and Heart Failure With Reduced Ejection Fraction. Circulation. 2017; 135(16):1547-63.
32.      Tsang TS, Barnes ME, Bailey KR, Leibson CL, Montgomery SC, Takemoto Y, et al. Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc. 2001; 76(5):467-75.
33.      Seko Y, Kato T, Haruna T, Izumi T, Miyamoto S, Nakane E, et al. Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling. Sci Rep. 2018; 8(1):6366.
34.      Allessie MA, Konings K, Kirchhof CJ, Wijffels M. Electrophysiologic mechanisms of perpetuation of atrial fibrillation. Am J Cardiol. 1996; 77(3):10A-23A.
35.      Gertz ZM, Raina A, Saghy L, Zado ES, Callans DJ, Marchlinski FE, et al. Evidence of atrial functional mitral regurgitation due to atrial fibrillation: reversal with arrhythmia control. J Am Coll Cardiol. 2011; 58(14):1474-81.
36.      Liang JJ, Silvestry FE. Mechanistic insights into mitral regurgitation due to atrial fibrillation: "Atrial functional mitral regurgitation". Trends Cardiovasc Med. 2016; 26(8):681-9.
37.      Patlolla SH, Schaff HV, Nishimura RA, Stulak JM, Chamberlain AM, Pislaru SV, et al. Incidence and Burden of Tricuspid Regurgitation in Patients With Atrial Fibrillation. J Am Coll Cardiol. 2022; 80(24):2289-98.
Iranian Heart Journal
Volume 27, Issue 4
Autumn 2026
Pages 16-24