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Mitral annular calcification and incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis
Wesley T O'Neal1, Jimmy T Efird2, Saman Nazarian3
1Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA woneal@wakehealth.edu.
Aims:
The associations of mitral annular calcification (MAC) with atrial fibrillation (AF) risk factors and related outcomes suggest a possible association between MAC and AF. The aim of this study was to examine the association between MAC and AF in a racially and ethnically diverse population.
Methods And Results:
This analysis included 6641 participants (mean age 62 ± 10 years; 53% women; 27% Blacks; 22% Hispanics; 12% Chinese-Americans) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were free of clinical cardiovascular disease and AF at baseline. The presence of MAC was defined by cardiac computed tomography (CT) as an Agatston score >0. Atrial fibrillation was ascertained by hospital discharge records and from Medicare claims data until 31 December 2010. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association between MAC and AF. At baseline, 619 (9.3%) participants had MAC. Over a median follow-up of 8.5 years, 308 (4.6%) participants developed AF. In a multivariable adjusted model, MAC was associated with an increased risk of AF (HR = 1.9, 95% CI = 1.5, 2.5). This association was consistent across subgroups of age, sex, race/ethnicity (Whites vs. non-Whites), hypertension, diabetes, and left atrial enlargement. The addition of MAC to the Framingham Heart Study and CHARGE AF risk scores for AF improved the C-statistics from 0.769 to 0.776 (P = 0.038) and 0.788 to 0.792 (P = 0.089), respectively.
Conclusion:
The presence of MAC was predictive of incident AF in MESA. Potentially, these findings suggest a usefulness of cardiac CT to identify individuals at risk for AF.
Insights
Mitral annular calcification (MAC) is linked to a higher risk of developing atrial fibrillation (AF). Cardiac CT can help identify individuals at risk for AF.
Area of Science:
- Cardiology
- Medical Imaging
- Epidemiology
Background:
- Mitral annular calcification (MAC) is associated with risk factors for atrial fibrillation (AF).
- Previous studies suggest a potential link between MAC and AF.
- The association needs further investigation in diverse populations.
Purpose of the Study:
- To investigate the association between MAC and incident AF.
- To examine this association in a racially and ethnically diverse cohort.
- To assess the predictive value of MAC for AF risk.
Main Methods:
- Analysis of 6641 participants from the Multi-Ethnic Study of Atherosclerosis (MESA).
- MAC presence determined by cardiac computed tomography (CT) Agatston score >0.
- AF ascertained via hospital records and Medicare claims; Cox regression used for analysis.
Main Results:
- 9.3% of participants had MAC at baseline.
- Over 8.5 years, 4.6% developed AF.
- MAC was associated with a 1.9-fold increased risk of AF (HR=1.9, 95% CI=1.5-2.5), consistent across subgroups.
Conclusions:
- MAC presence predicts incident AF in the MESA cohort.
- Cardiac CT may be useful for identifying individuals at risk for AF.
- Findings highlight MAC as a potential biomarker for AF risk stratification.
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