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J Am Coll Cardiol. 2014 May 20;63(19):2007-13. doi: 10.1016/j.jacc.2014.01.066. Epub 2014 Mar 19.

Association of electrocardiographic and imaging surrogates of left ventricular hypertrophy with incident atrial fibrillation: MESA (Multi-Ethnic Study of Atherosclerosis).

Author information

1
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: chrispin@jhmi.edu.
2
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
3
Departments of Epidemiology and Prevention and Internal Medicine, Cardiology Section, Epidemiological Cardiology Research Center (EPICARE), Wake Forest University School of Medicine, Winston-Salem, North Carolina.
4
Welch Center for Prevention, Epidemiology and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
5
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
6
Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington.
7
Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center and National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland.
8
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Abstract

OBJECTIVES:

This study sought to examine the association between left ventricular hypertrophy (LVH), defined by cardiac magnetic resonance (CMR) and electrocardiography (ECG), with incident atrial fibrillation (AF).

BACKGROUND:

Previous studies of the association between AF and LVH were based primarily on echocardiographic measures of LVH.

METHODS:

The MESA (Multi-Ethnic Study of Atherosclerosis) enrolled 4,942 participants free of clinically recognized cardiovascular disease. Incident AF was based on MESA-ascertained hospital-discharge International Classification of Diseases codes and Centers for Medicare and Medicaid Services inpatient hospital claims. CMR-LVH was defined as left ventricular mass ≥95th percentile of the MESA population distribution. Eleven ECG-LVH criteria were assessed. The association of LVH with incident AF was evaluated using multivariable Cox proportional hazards models adjusted for CVD risk factors.

RESULTS:

During a median follow-up of 6.9 years, 214 incident AF events were documented. Participants with AF were more likely to be older, hypertensive, and overweight. The risk of AF was greater in participants with CMR-derived LVH (hazard ratio [HR]: 2.04, 95% confidence interval [CI]: 1.15 to 3.62). AF was associated with ECG-derived LVH measure of Sokolow-Lyon voltage product after adjusting for CMR-LVH (HR: 1.83, 95% CI: 1.06 to 3.14, p = 0.02). The associations with AF for CMR-LVH and Sokolow-Lyon voltage product were attenuated when adjusted for CMR left atrial volumes.

CONCLUSIONS:

In a multiethnic cohort of participants without clinically detected cardiovascular disease, both CMR and ECG-derived LVH were associated with incident AF. ECG-LVH showed prognostic significance independent of CMR-LVH. The association was attenuated when adjusted for CMR left atrial volumes.

KEYWORDS:

atrial fibrillation; cardiac magnetic resonance imaging; electrocardiography; left ventricular hypertrophy

PMID:
24657688
PMCID:
PMC4024364
DOI:
10.1016/j.jacc.2014.01.066
[Indexed for MEDLINE]
Free PMC Article
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