Diastolic dysfunction (DD) is associated with incident atrial fibrillation (AF). The influence of heart rate at rest (RHR) on incident AF in patients with DD has not been investigated. The goal of this study is to assess the influence of RHR on incident AF in patients with DD. Patients from a large health system with no previous history of AF, a left ventricular ejection fraction ≥50%, and documented DD on echocardiography were divided into quartiles (<66, 66 to 76, 77 to 91, >91 beats per minute) based on RHR. Incident AF was estimated using AF hospitalization during follow-up. Hazard ratios (HR) for AF hospitalization and all-cause death were calculated with a Cox proportional hazards model. A total of 19,046 patients were analyzed. Over a median follow-up of 42.2 months, 742 (3.9%) patients were hospitalized for AF. Both slower and faster RHR were associated with increased risk of AF hospitalization (HR 1.40, confidence interval [CI] 1.14 to 1.71, p = 0.001, HR 1.23, CI 0.99 to 1.53, p = 0.06 and HR 1.72, CI 1.38 to 2.14, p <0.001, for quartiles 1, 2, and 4, respectively), suggesting a J-shaped relation. Progressive increase in all-cause death was noted with faster RHR (HR1.19 per quartile increase, CI 1.16 to 1.22, p <0.001). These results persisted after adjustment for age, cardiovascular co-morbidities, grade of DD, and β-blocker use. In conclusion, this large, real-world analysis indicates increased risk of incident AF with slower and faster RHR in patients with DD. Randomized trials are needed to evaluate the potential of RHR modification to mitigate the risk of incident AF.

中文翻译：

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舒张功能不全患者的静息心率和房颤发生情况

舒张功能障碍 (DD) 与心房颤动 (AF) 相关。尚未研究静息心率 (RHR) 对 DD 患者发生 AF 的影响。本研究的目的是评估 RHR 对 DD 患者发生 AF 的影响。来自大型卫生系统、既往无 AF 病史、左心室射血分数≥50%、超声心动图记录 DD 的患者被分为四分位数（<66、66 至 76、77 至 91、>91 次/分钟）。在 RHR 上。 AF 事件是根据随访期间 AF 住院情况估计的。使用 Cox 比例风险模型计算房颤住院和全因死亡的风险比 (HR)。总共分析了 19,046 名患者。在中位随访 42.2 个月中，742 名患者 (3.9%) 因 AF 住院。较慢和较快的 RHR 均与 AF 住院风险增加相关（HR 1.40，置信区间 [CI] 1.14 至 1.71，p = 0.001，HR 1.23，CI 0.99 至 1.53，p = 0.06 和 HR 1.72，CI 1.38 至 2.14， p <0.001，分别为四分位数 1、2 和 4），表明存在 J 形关系。随着 RHR 加快，全因死亡逐渐增加（每四分位数增加 HR1.19，CI 1.16 至 1.22，p <0.001）。在调整年龄、心血管合并症、DD 等级和 β 受体阻滞剂使用后，这些结果仍然存在。总之，这项大规模的现实分析表明，DD 患者的 RHR 较慢和较快，发生 AF 的风险会增加。需要进行随机试验来评估 RHR 修改降低 AF 风险的潜力。