TY - JOUR
T1 - Change in Left Atrioventricular Coupling Index to Predict Incident Atrial Fibrillation
T2 - The Multi-Ethnic Study of Atherosclerosis (MESA)
AU - Pezel, Théo
AU - Ambale-Venkatesh, Bharath
AU - Quinaglia, Thiago
AU - Heckbert, Susan R.
AU - Kato, Yoko
AU - de Vasconcellos, Henrique Doria
AU - Wu, Colin O.
AU - Post, Wendy S.
AU - Henry, Patrick
AU - Bluemke, David A.
AU - Lima, João A.C.
N1 - Funding Information:
S.R.H. supported by the National Institutes of Health, American Heart Association grants. P.H. supported by the National Institutes of Health. J.A.C.L. supported by the National Institutes of Health.
Funding Information:
tional grant from Cannon Medical Systems, Myocardial Solutions. T.Q. No relevant relationships. S.R.H. Data safety monitoring board for University at California, San Francisco. Y.K. No relevant relationships. H.D.d.V. Data safety monitoring board at Johns Hopkins. C.O.W. No relevant relationships. W.S.P. NIH grant to Johns Hopkins. P.H. No relevant relationships. D.A.B. Editor-in-chief of Radiology. J.A.C.L. Member of the Radiology editorial board.
Publisher Copyright:
© RSNA, 2022.
PY - 2022/5
Y1 - 2022/5
N2 - Background: Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF). Purpose: To investigate the prognostic value of a left atrioventricular coupling index (LACI) and average annualized change in LACI (hereafter, ΔLACI) measured by cardiac MRI to predict incident AF in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA). Materials and Methods: In a secondary analysis of the prospective MESA, 1911 study participants without clinically recognized AF and cardiovascular disease at baseline had LACI assessed with cardiac MRI at baseline (examination 1, 2000-2002) and 10 years later (examination 5, 2010-2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average ΔLACI with incident AF. Results: Among the 1911 participants (mean age, 59 years 6 9 [standard deviation]; 907 men), 87 incident AF events occurred over 3.9 years 6 0.9 after the second imaging (examination 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (hazard ratio, 1.69 [95% CI: 1.46, 1.96] and 1.71 [95% CI: 1.50, 1.94], respectively; both P , .001). Adjusted models for LACI and ΔLACI showed improvement in model discrimination compared with currently used AF risk score (Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score) model (area under receiver operating characteristic curve [AUC], 0.78 vs 0.74; and AUC, 0.80 vs 0.74, respectively; both P , .001); and to the final model including individual LA or LV parameters for predicting AF incidence (AUC, 0.78 vs 0.76; and AUC, 0.80 vs 0.78, respectively; both P , .001). Conclusion: Atrioventricular coupling (left atrioventricular coupling index [LACI]) and coupling change (annual change in LACI) were strong predictors for atrial fibrillation (AF) in a multiethnic population. Both had incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination compared with the Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score and to individual left atrial or left ventricular parameters.
AB - Background: Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF). Purpose: To investigate the prognostic value of a left atrioventricular coupling index (LACI) and average annualized change in LACI (hereafter, ΔLACI) measured by cardiac MRI to predict incident AF in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA). Materials and Methods: In a secondary analysis of the prospective MESA, 1911 study participants without clinically recognized AF and cardiovascular disease at baseline had LACI assessed with cardiac MRI at baseline (examination 1, 2000-2002) and 10 years later (examination 5, 2010-2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average ΔLACI with incident AF. Results: Among the 1911 participants (mean age, 59 years 6 9 [standard deviation]; 907 men), 87 incident AF events occurred over 3.9 years 6 0.9 after the second imaging (examination 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (hazard ratio, 1.69 [95% CI: 1.46, 1.96] and 1.71 [95% CI: 1.50, 1.94], respectively; both P , .001). Adjusted models for LACI and ΔLACI showed improvement in model discrimination compared with currently used AF risk score (Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score) model (area under receiver operating characteristic curve [AUC], 0.78 vs 0.74; and AUC, 0.80 vs 0.74, respectively; both P , .001); and to the final model including individual LA or LV parameters for predicting AF incidence (AUC, 0.78 vs 0.76; and AUC, 0.80 vs 0.78, respectively; both P , .001). Conclusion: Atrioventricular coupling (left atrioventricular coupling index [LACI]) and coupling change (annual change in LACI) were strong predictors for atrial fibrillation (AF) in a multiethnic population. Both had incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination compared with the Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score and to individual left atrial or left ventricular parameters.
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U2 - 10.1148/radiol.210315
DO - 10.1148/radiol.210315
M3 - Article
C2 - 35191736
AN - SCOPUS:85129778428
SN - 0033-8419
VL - 303
SP - 317
EP - 326
JO - RADIOLOGY
JF - RADIOLOGY
IS - 2
ER -