Mitral annular calcification and incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis

Wesley T. O'Neal, Jimmy T. Efird, Saman Nazarian, Alvaro Alonso, Susan R. Heckbert, Elsayed Z. Soliman

Research output: Contribution to journalArticle

Abstract

Aims The associations of mitral annular calcification (MAC) with atrial fibrillation (AF) risk factors and related outcomes suggest a possible association between MAC and AF. The aim of this study was to examine the association between MAC and AF in a racially and ethnically diverse population. Methods and results This analysis included 6641 participants (mean age 62 ± 10 years; 53% women; 27% Blacks; 22% Hispanics; 12% Chinese-Americans) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were free of clinical cardiovascular disease and AF at baseline. The presence of MAC was defined by cardiac computed tomography (CT) as an Agatston score >0. Atrial fibrillation was ascertained by hospital discharge records and from Medicare claims data until 31 December 2010. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association between MAC and AF. At baseline, 619 (9.3%) participants had MAC. Over a median follow-up of 8.5 years, 308 (4.6%) participants developed AF. In a multivariable adjusted model, MAC was associated with an increased risk of AF (HR = 1.9, 95% CI = 1.5, 2.5). This association was consistent across subgroups of age, sex, race/ethnicity (Whites vs. non-Whites), hypertension, diabetes, and left atrial enlargement. The addition of MAC to the Framingham Heart Study and CHARGE AF risk scores for AF improved the C-statistics from 0.769 to 0.776 (P = 0.038) and 0.788 to 0.792 (P = 0.089), respectively. Conclusion The presence of MAC was predictive of incident AF in MESA. Potentially, these findings suggest a usefulness of cardiac CT to identify individuals at risk for AF.

Original languageEnglish (US)
Pages (from-to)358-363
Number of pages6
JournalEuropace
Volume17
Issue number3
DOIs
StatePublished - Jan 27 2015

Keywords

  • Atrial fibrillation
  • Epidemiology
  • Mitral annulus calcification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    O'Neal, W. T., Efird, J. T., Nazarian, S., Alonso, A., Heckbert, S. R., & Soliman, E. Z. (2015). Mitral annular calcification and incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis. Europace, 17(3), 358-363. https://doi.org/10.1093/europace/euu265