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Multicenter Study
. 2014 May 20;63(19):2007-13.
doi: 10.1016/j.jacc.2014.01.066. Epub 2014 Mar 19.

Association of electrocardiographic and imaging surrogates of left ventricular hypertrophy with incident atrial fibrillation: MESA (Multi-Ethnic Study of Atherosclerosis)

Jonathan Chrispin  1 , Aditya Jain  2 , Elsayed Z Soliman  3 , Eliseo Guallar  4 , Alvaro Alonso  5 , Susan R Heckbert  6 , David A Bluemke  7 , João A C Lima  2 , Saman Nazarian  8
Affiliations
Multicenter Study

Association of electrocardiographic and imaging surrogates of left ventricular hypertrophy with incident atrial fibrillation: MESA (Multi-Ethnic Study of Atherosclerosis)

Jonathan Chrispin et al. J Am Coll Cardiol. .

Abstract

Objectives: This study sought to examine the association between left ventricular hypertrophy (LVH), defined by cardiac magnetic resonance (CMR) and electrocardiography (ECG), with incident atrial fibrillation (AF).

Background: Previous studies of the association between AF and LVH were based primarily on echocardiographic measures of LVH.

Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) enrolled 4,942 participants free of clinically recognized cardiovascular disease. Incident AF was based on MESA-ascertained hospital-discharge International Classification of Diseases codes and Centers for Medicare and Medicaid Services inpatient hospital claims. CMR-LVH was defined as left ventricular mass ≥95th percentile of the MESA population distribution. Eleven ECG-LVH criteria were assessed. The association of LVH with incident AF was evaluated using multivariable Cox proportional hazards models adjusted for CVD risk factors.

Results: During a median follow-up of 6.9 years, 214 incident AF events were documented. Participants with AF were more likely to be older, hypertensive, and overweight. The risk of AF was greater in participants with CMR-derived LVH (hazard ratio [HR]: 2.04, 95% confidence interval [CI]: 1.15 to 3.62). AF was associated with ECG-derived LVH measure of Sokolow-Lyon voltage product after adjusting for CMR-LVH (HR: 1.83, 95% CI: 1.06 to 3.14, p = 0.02). The associations with AF for CMR-LVH and Sokolow-Lyon voltage product were attenuated when adjusted for CMR left atrial volumes.

Conclusions: In a multiethnic cohort of participants without clinically detected cardiovascular disease, both CMR and ECG-derived LVH were associated with incident AF. ECG-LVH showed prognostic significance independent of CMR-LVH. The association was attenuated when adjusted for CMR left atrial volumes.

Keywords: atrial fibrillation; cardiac magnetic resonance imaging; electrocardiography; left ventricular hypertrophy.

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Conflict of interest statement

Disclosures: Dr Nazarian is a scientific advisor to and PI for research funding to Johns Hopkins University from Biosense-Webster Incorporated. The other authors declare no conflicts of interest.

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