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Peer-reviewedCC BY 4.0PLOS One

Atrial fibrillation is independently associated with impaired myocardial perfusion

  • Niklas Vartiainen1
  • Suvi Hartikainen1,2
  • Antti-Pekka E. Rissanen3,4,5
  • Elina Kariniemi1,6
  • Aleksi J. Leikas7,8,9
  • Eero Strengell10
  • Svantte Halttunen11
  • Paavo-Ilari Kuikka10
  • Juha E. K. Hartikainen2,8,9
  • Tomi P. Laitinen1,2
11 affiliations
  1. 1Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, North Savo, Finland
  2. 2Institute of Clinical Medicine, University of Eastern Finland, Kuopio, North Savo, Finland
  3. 3Helsinki Sports and Exercise Medicine Clinic (HULA), Foundation for Sports and Exercise Medicine, Helsinki, Uusimaa, Finland
  4. 4Sports and Exercise Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Uusimaa, Finland
  5. 5Department of Medicine, Kuopio University Hospital, Kuopio, North Savo, Finland
  6. 6Department of Clinical Radiology, Kuopio University Hospital, Kuopio, North Savo, Finland
  7. 7A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, North Savo, Finland
  8. 8Heart Center, Kuopio University Hospital, Kuopio, North Savo, Finland
  9. 9Gene Therapy Unit, Kuopio University Hospital, Kuopio, North Savo, Finland
  10. 10Department of Clinical Physiology and Nuclear Medicine, Mikkeli Central Hospital, Mikkeli, South Savo, Finland
  11. 11Department of Clinical Physiology and Nuclear Medicine, North Karelia Central Hospital, Joensuu, North Karelia, Finland
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Abstract

A characteristic feature of obstructive coronary artery disease (CAD) is impaired myocardial blood flow (MBF). Previous studies have shown that atrial fibrillation (AF) is also associated with reduced hyperemic MBF. However, it is unknown whether an independent association exists between AF and MBF in symptomatic patients with suspected obstructive CAD. We studied 874 patients at Kuopio University Hospital (Finland) who underwent coronary computed tomography angiography (CCTA) and [15O]H2O myocardial perfusion positron emission tomography due to suspected obstructive CAD in 2017–2023. The final cohort comprised 31 AF patients and 120 propensity score-matched sinus rhythm (SR) patients. The matching criteria were age, sex, body mass index, number of traditional risk factors for CAD (0–5), calcium score, and total CCTA status (i.e., the overall severity of CCTA findings). Global hyperemic MBF was lower in AF patients than in SR patients (median 1.9 mL/g/min [IQR 1.4–2.6 mL/g/min] vs. 3.0 mL/g/min [IQR 2.4–3.6 mL/g/min], p < 0.001). Impaired hyperemic MBF (< 2.3 mL/g/min in ≥ 1 segment) was more frequent in AF patients (n = 25/31, 81%) than in SR patients (n = 50/120, 42%, p < 0.001). Furthermore, the presence of AF was independently associated with reduced hyperemic MBF in three multivariate general linear models (p < 0.001 in each model). To summarize, AF was independently associated with impaired hyperemic MBF in patients with suspected obstructive CAD. This association should be considered in clinical practice when interpreting the results of myocardial perfusion imaging in patients with AF.

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Cite

BibTeXRIS
BibTeX
@article{vartiainen2026atrial,
  title = {{Atrial fibrillation is independently associated with impaired myocardial perfusion}},
  author = {Niklas Vartiainen and Suvi Hartikainen and Antti-Pekka E. Rissanen and Elina Kariniemi and Aleksi J. Leikas and Eero Strengell and Svantte Halttunen and Paavo-Ilari Kuikka and Juha E. K. Hartikainen and Tomi P. Laitinen},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0361402},
  url = {https://doi.org/10.1371/journal.pone.0361402},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Atrial fibrillation is independently associated with impaired myocardial perfusion
AU  - Niklas Vartiainen
AU  - Suvi Hartikainen
AU  - Antti-Pekka E. Rissanen
AU  - Elina Kariniemi
AU  - Aleksi J. Leikas
AU  - Eero Strengell
AU  - Svantte Halttunen
AU  - Paavo-Ilari Kuikka
AU  - Juha E. K. Hartikainen
AU  - Tomi P. Laitinen
PY  - 2026
DA  - 2026/10/27
JO  - PLOS One
DO  - 10.1371/journal.pone.0361402
UR  - https://doi.org/10.1371/journal.pone.0361402
AB  - A characteristic feature of obstructive coronary artery disease (CAD) is impaired myocardial blood flow (MBF). Previous studies have shown that atrial fibrillation (AF) is also associated with reduced hyperemic MBF. However, it is unknown whether an independent association exists between AF and MBF in symptomatic patients with suspected obstructive CAD. We studied 874 patients at Kuopio University Hospital (Finland) who underwent coronary computed tomography angiography (CCTA) and [15O]H2O myocardial perfusion positron emission tomography due to suspected obstructive CAD in 2017–2023. The final cohort comprised 31 AF patients and 120 propensity score-matched sinus rhythm (SR) patients. The matching criteria were age, sex, body mass index, number of traditional risk factors for CAD (0–5), calcium score, and total CCTA status (i.e., the overall severity of CCTA findings). Global hyperemic MBF was lower in AF patients than in SR patients (median 1.9 mL/g/min [IQR 1.4–2.6 mL/g/min] vs. 3.0 mL/g/min [IQR 2.4–3.6 mL/g/min], p < 0.001). Impaired hyperemic MBF (< 2.3 mL/g/min in ≥ 1 segment) was more frequent in AF patients (n = 25/31, 81%) than in SR patients (n = 50/120, 42%, p < 0.001). Furthermore, the presence of AF was independently associated with reduced hyperemic MBF in three multivariate general linear models (p < 0.001 in each model). To summarize, AF was independently associated with impaired hyperemic MBF in patients with suspected obstructive CAD. This association should be considered in clinical practice when interpreting the results of myocardial perfusion imaging in patients with AF.
SN  - 1932-6203
ER  -