Author + information
- Received October 12, 2017
- Revision received December 12, 2017
- Accepted December 28, 2017
- Published online November 14, 2018.
- Flemming J. Olsen, MDa,b,∗ (, )
- Rasmus Møgelvang, MD, PhDa,b,
- Gorm B. Jensen, MD, DMSca,
- Jan S. Jensen, MD, PhD, DMSca,b,c and
- Tor Biering-Sørensen, MD, PhDa,b,d
- aCopenhagen City Heart Study, Copenhagen, Denmark
- bDepartment of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- cInstitute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- dDepartment of Medicine, Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Flemming J. Olsen, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
Objectives This study sought to investigate whether left atrial (LA) functional measures predict atrial fibrillation (AF) in the general population.
Background Increasing evidence suggests LA functional measures are predictors of AF in several patient groups.
Methods In a community-based cohort study, approximately 2,000 individuals underwent a transthoracic echocardiogram. Conventional echocardiographic measures and extended LA measures, including the minimal and maximal LA volumes (LAVmin and LAVmax, respectively) and left atrial emptying fraction (LAEF), were performed. The endpoint was incident AF, and participants with known AF were excluded, which left 1,951 for inclusion.
Results Over 11.0 years of follow-up, 184 (9.4%) developed AF. Those who developed AF had significantly larger LA volumes and lower LAEF than participants free of AF. These LA measures were univariable predictors of AF (LAVmax hazard ratio [HR]: 1.10 [95% confidence interval (CI): 1.08 to 1.12] per 1-ml increase, p < 0.001; LAVmin HR: 1.14 [95% CI: 1.12 to 1.16] per 1-ml increase, p < 0.001; LAEF HR: 1.03 [95% CI: 1.02 to 1.04] per percent decrease, p < 0.001). All LA measures remained predictors independent of clinical risk scores, with LAVmin providing the highest C-statistics when added to these risk scores (C-statistic for CHADS2 0.728 vs. CHADS2 + LAVmin 0.778; C-statistic for CHARGE-AF 0.815 vs. CHARGE-AF + LAVmin 0.830). However, hypertension modified the relationship between the measures of LA function (both LAVmin and LAEF) and risk of AF (p for interaction < 0.001), which was not the case for LAVmax (p = 0.22). The measures of LA function mainly provided prognostic information regarding risk of AF in participants without hypertension. Even when we restricted our analysis to individuals without hypertension and nondilated LA (LAVmax<34 ml/m2), the LAVmin and LAEF remained significantly independent predictors of AF after multivariable adjustments (LAVmin HR: 1.12 [95% CI: 1.01 to 1.24], p = 0.028, and LAEF HR: 1.03 [95% CI: 1.00 to 1.06], p = 0.021, respectively).
Conclusions LA functional measures predict AF in the general population and provide prognostic information incremental to clinical risk scores. In individuals without hypertension and nondilated LA, these measures indicate an increased risk of AF.
The Copenhagen City Heart Study was financially supported by the Danish Heart Foundation, and the echocardiographic substudy of the 4th round of examination was supported by the Lundbeck Foundation. Dr. Olsen was funded by grants from the Herlev & Gentofte Hospital’s Research Council and the P. Carl Petersen Foundation. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 12, 2017.
- Revision received December 12, 2017.
- Accepted December 28, 2017.
- 2018 American College of Cardiology Foundation
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