Change in left atrial function predicts incident atrial fibrillation

the Multi-Ethnic Study of Atherosclerosis

Daniel J. Lim, Bharath Ambale-Ventakesh, Mohammad R. Ostovaneh, Tarek Zghaib, Hiroshi Ashikaga, Colin Wu, Karol E. Watson, Timothy Hughes, Steven Shea, Susan R. Heckbert, David A. Bluemke, Wendy S Post, Joao Lima

Research output: Contribution to journalArticle

Abstract

AIMS: Longitudinal change in left atrial (LA) structure and function could be helpful in predicting risk for incident atrial fibrillation (AF). We used cardiac magnetic resonance (CMR) imaging to explore the relationship between change in LA structure and function and incident AF in a multi-ethnic population free of clinical cardiovascular disease at baseline. METHODS AND RESULTS: In the Multi-Ethnic Study of Atherosclerosis (MESA), 2338 participants, free at baseline of clinically recognized AF and cardiovascular disease, had LA volume and function assessed with CMR imaging, at baseline (2000-02), and at Exam 4 (2005-07) or 5 (2010-12). Free of AF, 124 participants developed AF over 3.8 ± 0.9 years (2015) following the second imaging. In adjusted Cox regression models, an average annualized change in all LA parameters were significantly associated with an increased risk of AF. An annual decrease of 1-SD unit in total LA emptying fractions (LAEF) was most strongly associated with risk of AF after adjusting for clinical risk factors for AF, baseline LA parameters, and left ventricular mass-to-volume ratio (hazard ratio per SD = 1.91, 95% confidence interval = 1.53-2.38, P < 0.001). The addition of change in total LAEF to an AF risk score improved model discrimination and reclassification (net reclassification improvement = 0.107, P = 0.017; integrative discrimination index = 0.049, P < 0.001). CONCLUSION: In this multi-ethnic study population free of clinical cardiovascular disease at baseline, a greater increase in LA volumes and decrease in LA function were associated with incident AF. The addition of change in total LAEF to risk prediction models for AF improved model discrimination and reclassification of AF risk.

Original languageEnglish (US)
Pages (from-to)979-987
Number of pages9
JournalEuropean heart journal cardiovascular Imaging
Volume20
Issue number9
DOIs
StatePublished - Sep 1 2019

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Left Atrial Function
Atrial Fibrillation
Atherosclerosis
Cardiovascular Diseases
Magnetic Resonance Imaging
Proportional Hazards Models
Population

Keywords

  • atrial fibrillation
  • left atrium

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Change in left atrial function predicts incident atrial fibrillation : the Multi-Ethnic Study of Atherosclerosis. / Lim, Daniel J.; Ambale-Ventakesh, Bharath; Ostovaneh, Mohammad R.; Zghaib, Tarek; Ashikaga, Hiroshi; Wu, Colin; Watson, Karol E.; Hughes, Timothy; Shea, Steven; Heckbert, Susan R.; Bluemke, David A.; Post, Wendy S; Lima, Joao.

In: European heart journal cardiovascular Imaging, Vol. 20, No. 9, 01.09.2019, p. 979-987.

Research output: Contribution to journalArticle

Lim, DJ, Ambale-Ventakesh, B, Ostovaneh, MR, Zghaib, T, Ashikaga, H, Wu, C, Watson, KE, Hughes, T, Shea, S, Heckbert, SR, Bluemke, DA, Post, WS & Lima, J 2019, 'Change in left atrial function predicts incident atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis', European heart journal cardiovascular Imaging, vol. 20, no. 9, pp. 979-987. https://doi.org/10.1093/ehjci/jez176
Lim, Daniel J. ; Ambale-Ventakesh, Bharath ; Ostovaneh, Mohammad R. ; Zghaib, Tarek ; Ashikaga, Hiroshi ; Wu, Colin ; Watson, Karol E. ; Hughes, Timothy ; Shea, Steven ; Heckbert, Susan R. ; Bluemke, David A. ; Post, Wendy S ; Lima, Joao. / Change in left atrial function predicts incident atrial fibrillation : the Multi-Ethnic Study of Atherosclerosis. In: European heart journal cardiovascular Imaging. 2019 ; Vol. 20, No. 9. pp. 979-987.
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abstract = "AIMS: Longitudinal change in left atrial (LA) structure and function could be helpful in predicting risk for incident atrial fibrillation (AF). We used cardiac magnetic resonance (CMR) imaging to explore the relationship between change in LA structure and function and incident AF in a multi-ethnic population free of clinical cardiovascular disease at baseline. METHODS AND RESULTS: In the Multi-Ethnic Study of Atherosclerosis (MESA), 2338 participants, free at baseline of clinically recognized AF and cardiovascular disease, had LA volume and function assessed with CMR imaging, at baseline (2000-02), and at Exam 4 (2005-07) or 5 (2010-12). Free of AF, 124 participants developed AF over 3.8 ± 0.9 years (2015) following the second imaging. In adjusted Cox regression models, an average annualized change in all LA parameters were significantly associated with an increased risk of AF. An annual decrease of 1-SD unit in total LA emptying fractions (LAEF) was most strongly associated with risk of AF after adjusting for clinical risk factors for AF, baseline LA parameters, and left ventricular mass-to-volume ratio (hazard ratio per SD = 1.91, 95{\%} confidence interval = 1.53-2.38, P < 0.001). The addition of change in total LAEF to an AF risk score improved model discrimination and reclassification (net reclassification improvement = 0.107, P = 0.017; integrative discrimination index = 0.049, P < 0.001). CONCLUSION: In this multi-ethnic study population free of clinical cardiovascular disease at baseline, a greater increase in LA volumes and decrease in LA function were associated with incident AF. The addition of change in total LAEF to risk prediction models for AF improved model discrimination and reclassification of AF risk.",
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AU - Lim, Daniel J.

AU - Ambale-Ventakesh, Bharath

AU - Ostovaneh, Mohammad R.

AU - Zghaib, Tarek

AU - Ashikaga, Hiroshi

AU - Wu, Colin

AU - Watson, Karol E.

AU - Hughes, Timothy

AU - Shea, Steven

AU - Heckbert, Susan R.

AU - Bluemke, David A.

AU - Post, Wendy S

AU - Lima, Joao

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N2 - AIMS: Longitudinal change in left atrial (LA) structure and function could be helpful in predicting risk for incident atrial fibrillation (AF). We used cardiac magnetic resonance (CMR) imaging to explore the relationship between change in LA structure and function and incident AF in a multi-ethnic population free of clinical cardiovascular disease at baseline. METHODS AND RESULTS: In the Multi-Ethnic Study of Atherosclerosis (MESA), 2338 participants, free at baseline of clinically recognized AF and cardiovascular disease, had LA volume and function assessed with CMR imaging, at baseline (2000-02), and at Exam 4 (2005-07) or 5 (2010-12). Free of AF, 124 participants developed AF over 3.8 ± 0.9 years (2015) following the second imaging. In adjusted Cox regression models, an average annualized change in all LA parameters were significantly associated with an increased risk of AF. An annual decrease of 1-SD unit in total LA emptying fractions (LAEF) was most strongly associated with risk of AF after adjusting for clinical risk factors for AF, baseline LA parameters, and left ventricular mass-to-volume ratio (hazard ratio per SD = 1.91, 95% confidence interval = 1.53-2.38, P < 0.001). The addition of change in total LAEF to an AF risk score improved model discrimination and reclassification (net reclassification improvement = 0.107, P = 0.017; integrative discrimination index = 0.049, P < 0.001). CONCLUSION: In this multi-ethnic study population free of clinical cardiovascular disease at baseline, a greater increase in LA volumes and decrease in LA function were associated with incident AF. The addition of change in total LAEF to risk prediction models for AF improved model discrimination and reclassification of AF risk.

AB - AIMS: Longitudinal change in left atrial (LA) structure and function could be helpful in predicting risk for incident atrial fibrillation (AF). We used cardiac magnetic resonance (CMR) imaging to explore the relationship between change in LA structure and function and incident AF in a multi-ethnic population free of clinical cardiovascular disease at baseline. METHODS AND RESULTS: In the Multi-Ethnic Study of Atherosclerosis (MESA), 2338 participants, free at baseline of clinically recognized AF and cardiovascular disease, had LA volume and function assessed with CMR imaging, at baseline (2000-02), and at Exam 4 (2005-07) or 5 (2010-12). Free of AF, 124 participants developed AF over 3.8 ± 0.9 years (2015) following the second imaging. In adjusted Cox regression models, an average annualized change in all LA parameters were significantly associated with an increased risk of AF. An annual decrease of 1-SD unit in total LA emptying fractions (LAEF) was most strongly associated with risk of AF after adjusting for clinical risk factors for AF, baseline LA parameters, and left ventricular mass-to-volume ratio (hazard ratio per SD = 1.91, 95% confidence interval = 1.53-2.38, P < 0.001). The addition of change in total LAEF to an AF risk score improved model discrimination and reclassification (net reclassification improvement = 0.107, P = 0.017; integrative discrimination index = 0.049, P < 0.001). CONCLUSION: In this multi-ethnic study population free of clinical cardiovascular disease at baseline, a greater increase in LA volumes and decrease in LA function were associated with incident AF. The addition of change in total LAEF to risk prediction models for AF improved model discrimination and reclassification of AF risk.

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