Abstract 2591: Association of Left Ventricular Mass and Ejection Fraction with New-Onset Atrial Fibrillation in a Population-Based Sample: The Strong Heart Study
Background: Atrial fibrillation (AF) has been associated with increased inflammatory markers as well as increased left ventricular mass and decreased left ventricular ejection fraction (LVEF). However, whether increased LV mass or decreased LVEF predicts new-onset AF in a population-based sample has not been examined.
Methods: 3541 participants in the 2nd Strong Heart Study examination between 1993–1995, aged 47– 80 years, with inflammatory marker determinations and no prior AF, were followed for 10 years. New-onset AF was ascertained by review of medical records and ECG Minnesota coding.
Results: In a multivariable Cox model including age, gender, hypertension, diabetes (DM), body mass index (BMI), log urinary albumin/creatinine ratio (UACR), CRP, and fibrinogen, new-onset AF in 91 participants was predicted by LV mass indexed for height2.7 (LVMI) (HR 1.49 per 11 gm/m2.7 (1 SD of mean) [95% CI 1.24 –1.78], p≤0.0001) independent of effects of age (HR 1.08 per year [95% CI 1.05–1.11], p≤0.0001), hypertension (HR 1.81 [95% CI 1.10 –2.98], p=0.019), CRP (HR 1.30 [95% CI 1.02–1.66], p=0.038), and male gender (HR 1.80 [95% CI 1.16 –2.79], p=0.009). In a Cox model with LVEF substituted for LVMI, new-onset AF in 88 participants was predicted by LVEF (HR 0.65 per 14% (1 SD of mean) [95% CI 0.52– 0.82], p≤0.0001) independent of effects of age (HR 1.09 [95% CI 1.06 –1.12], p≤0.0001), hypertension (HR 2.02 [95% CI 1.22–3.33], p=0.006), and CRP (HR 1.29 [95% CI 1.00 –1.66], p=0.05). Male gender was not associated with new-onset AF in this model. In a Cox model with LVMI and LVEF entered, new-onset AF in 88 participants was predicted by LVMI (HR 1.31 per 11 gm/m2.7 [95% CI 1.05–1.65], p=0.018) and by LVEF (HR 0.73 per 14% [95% CI 0.57– 0.93], p=0.01), independent of effects of age (HR 1.08 [95% CI 1.05–1.11], p≤0.0001), HTN (HR 1.90 [95% CI 1.14 –3.14], p=0.013), and male gender (HR 1.56 [95% CI 0.99 –2.46], p=0.05). CRP was not associated with new-onset AF in this model. DM, BMI, UACR, and fibrinogen were not associated with new-onset AF in any of the models.
Conclusions: This study provides evidence that LV mass and LVEF are additive risk factors for new-onset AF in a population-based sample, independent of effects of gender, age, DM, hypertension, BMI, UACR, CRP, and fibrinogen.