Abstract 13905: Global Longitudinal Strain is an Independent Predictor of Incident Atrial Fibrillation in the Elderly: a Community-Based Cohort Study
Background: Atrial fibrillation (AF) prevalence is increasing; it is therefore important to improve AF risk prediction to implement preventive strategies. While heart failure is an established risk factor for AF, it is not known whether global longitudinal strain (GLS), a parameter able to detect early left ventricular (LV) systolic dysfunction before LV ejection fraction (LVEF), can predict incident AF in the general population and especially in the elderly, who are at greater risk of AF and stroke.
Methods: Participants from the community-based Northern Manhattan Study underwent two-dimensional speckle-tracking echocardiography as part of the Cardiac Abnormalities and Brain Lesions (CABL) study, and were followed up for incident AF. Subjects with history of AF, AF at enrollment, or significant valve disease were excluded. LV systolic function was assessed by LVEF and by speckle-tracking GLS.
Results: Mean age of the study sample (n=633) was 71±9 years, 61% were women, 77% had hypertension, 27% diabetes, and 5% history of coronary artery disease. During a mean follow-up of 5.4±1.5 years, 28 new cases of AF (4.4%) were recorded. GLS was significantly lower in those who developed AF compared to those who did not (-15.4±4.3% vs. -17.3±2.9%, p<0.01), whereas no difference in LVEF was seen between the two groups (62.9±11.3% vs. 63.4±6.8%, p=0.67). In multivariate analysis adjusted for age, sex, obesity, hypertension, LV mass, relative wall thickness, LVEF, left atrial volume, and diastolic dysfunction, lower GLS was associated with incident AF with an adjusted odds ratio (OR)=1.23 per 1% GLS decrease [95% confidence intervals (CI)=1.07-1.42, p<0.05]. The lowest quintile of GLS was associated with a significantly greater risk of incident AF compared to the other quintiles (8.9% vs. 3.3%, p<0.01) with an adjusted OR=2.83 (95% CI=1.14-7.03, p<0.05).
Conclusions: In an elderly community cohort, lower LV systolic function assessed by GLS was associated with future development of AF, whereas LVEF was not. The association was independent of cardiovascular risk factors and established echocardiographic predictors of AF including left atrial volume. GLS assessment may significantly improve AF risk stratification in the elderly.
Author Disclosures: C. Russo: None. Z. Jin: None. F. Sera: None. E.S. Lee: None. S. Homma: None. T. Rundek: None. M.S. Elkind: None. R.L. Sacco: Consultant/Advisory Board; Modest; Boehringer Ingelheim Consultant on the design of a secondary stroke prevention trial with Dabigatran. M.R. Di Tullio: None.
- © 2014 by American Heart Association, Inc.