Abstract 10989: Association of Electrocardiographic and Imaging Surrogates of Left Ventricular Hypertrophy with Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis
Background: Elevated left ventricular mass has been associated with an increased risk of atrial fibrillation (AF). We sought to define the magnitude of association between incident AF and left ventricular hypertrophy (LVH) defined by cardiac magnetic resonance (CMR) and electrocardiography (ECG).
Methods: The MESA study includes 6814 clinically asymptomatic participants (45–84 years of age) who underwent ECG and CMR examinations at baseline enrollment during 2000–2002. The diagnosis of incident AF was based on hospital discharge ICD codes. Individuals who developed AF after cardiac surgery were excluded. Left ventricular mass > 95th percentile on CMR was defined as LVH. Eleven traditional ECG-LVH criteria were assessed. Multivariate Cox proportional hazards models adjusted for cardiovascular risk factors were used to evaluate the association of LVH as defined by CMR and ECG with incident AF.
Results: There were 113 incident AF events documented in 4,931 patients (age 61.5 ± 10.1 years, 2337 men) who had available measures of both CMR and ECG, during a median follow-up of 5.8 years. Patients with AF were more likely to be older, Caucasian, hypertensive, and overweight. In multivariate models, the risk of AF was greater in subjects with CMR-derived LVH (n=246) [Hazard ratio (HR) 3.7, 95% CI 1.6–8.5] as compared to those with </= 50th percentile of LV mass (reference group, n=2467). AF was also significantly predicted by ECG-derived LVH measures of Sokolow-Lyon voltage product [HR 2.7 (1.3, 5.4)], Cornell voltage product [HR 2.1 (1.2, 3.6)], and Perguia score [HR 3.0 (1.6, 5.5)]. These ECG criteria retained association with incident AF after adjusting for CMR-LVH in contrast to the latter which lost significance. None of the LVH measures showed a significant interaction with gender.
Conclusion: In a multi-ethnic cohort of patients without baseline cardiovascular disease, both CMR- and ECG-derived LVH were associated with incident AF. ECG-LVH showed prognostic significance independent of CMR-LVH.
- © 2010 by American Heart Association, Inc.