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Published on: July 20, 2022
Change in Left Atrioventricular Coupling Index to Predict Incident Atrial Fibrillation: The Multi-Ethnic Study of
Théo Pezel1, Bharath Ambale-Venkatesh1, Thiago Quinaglia1
1From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.).
Insights
The left atrioventricular coupling index (LACI) and its annual change predict atrial fibrillation (AF) risk. These measures improve AF prediction beyond traditional factors and existing scores.
Area of Science:
- Cardiology
- Medical Imaging
- Epidemiology
Background:
- Left atrial (LA) and left ventricular (LV) parameters predict atrial fibrillation (AF).
- Assessing atrioventricular coupling may offer further prognostic insights.
Purpose of the Study:
- To evaluate the prognostic value of the left atrioventricular coupling index (LACI) and its annualized change (ΔLACI) for predicting incident AF.
- To assess LACI and ΔLACI using cardiac MRI in a population-based sample.
Main Methods:
- Secondary analysis of the prospective Multi-Ethnic Study of Atherosclerosis (MESA) cohort.
- 1911 participants without baseline AF or cardiovascular disease underwent cardiac MRI at two time points, 10 years apart.
- LACI (LA to LV end-diastolic volume ratio) and ΔLACI were calculated; Cox models assessed associations with incident AF.
Main Results:
- Greater LACI and ΔLACI were independently associated with increased AF risk (HRs ~1.7, P < .001) after risk factor adjustment.
- Models including LACI and ΔLACI demonstrated improved discrimination for AF prediction compared to the CHARGE-AF score and individual LA/LV parameters (AUCs 0.78-0.80 vs 0.74-0.78).
Conclusions:
- Left atrioventricular coupling (LACI) and its change (ΔLACI) are strong, independent predictors of incident AF.
- LACI and ΔLACI provide incremental prognostic value for AF prediction, outperforming current risk scores and individual chamber parameters.
Abstract:
Background Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF). Purpose To investigate the prognostic value of a left atrioventricular coupling index (LACI) and average annualized change in LACI (hereafter, ΔLACI) measured by cardiac MRI to predict incident AF in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA). Materials and Methods In a secondary analysis of the prospective MESA, 1911 study participants without clinically recognized AF and cardiovascular disease at baseline had LACI assessed with cardiac MRI at baseline (examination 1, 2000-2002) and 10 years later (examination 5, 2010-2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average ΔLACI with incident AF. Results Among the 1911 participants (mean age, 59 years ± 9 [standard deviation]; 907 men), 87 incident AF events occurred over 3.9 years ± 0.9 after the second imaging (examination 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (hazard ratio, 1.69 [95% CI: 1.46, 1.96] and 1.71 [95% CI: 1.50, 1.94], respectively; both P < .001). Adjusted models for LACI and ΔLACI showed improvement in model discrimination compared with currently used AF risk score (Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score) model (area under receiver operating characteristic curve [AUC], 0.78 vs 0.74; and AUC, 0.80 vs 0.74, respectively; both P < .001); and to the final model including individual LA or LV parameters for predicting AF incidence (AUC, 0.78 vs 0.76; and AUC, 0.80 vs 0.78, respectively; both P < .001). Conclusion Atrioventricular coupling (left atrioventricular coupling index [LACI]) and coupling change (annual change in LACI) were strong predictors for atrial fibrillation (AF) in a multiethnic population. Both had incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination compared with the Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score and to individual left atrial or left ventricular parameters. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Leiner in this issue.
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