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Left ventricular hypertrophy phenotype to predict incident atrial fibrillation: The Multi-Ethnic Study of
Lili Wang1, Jiayi Yi1, Zeming Zhou1
1National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.
Insights
Left ventricular hypertrophy (LVH) phenotypes predict atrial fibrillation (AF) risk. Malignant LVH, with elevated biomarkers, poses the highest AF risk, improving prediction models.
Area of Science:
- Cardiology
- Cardiac Imaging
- Epidemiology
Background:
- Left ventricular hypertrophy (LVH) is linked to atrial fibrillation (AF).
- The predictive capability of different LVH phenotypes for incident AF requires further investigation.
- Understanding these associations is crucial for risk stratification and prevention strategies.
Purpose of the Study:
- To evaluate the predictive value of LVH phenotypes for incident AF.
- To compare the risk associated with isolated LVH versus malignant LVH.
- To assess the incremental predictive value of LVH phenotypes in existing AF risk models.
Main Methods:
- Utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA).
- Defined LVH using cardiac magnetic resonance imaging and cardiac biomarkers.
- Employed Receiver-Operating Characteristic (ROC) analysis to assess predictive performance.
Main Results:
- Included 4983 participants; 279 (5.6%) had isolated LVH, 222 (4.5%) had malignant LVH.
- During 8.5 years follow-up, 272 incident AF cases were observed.
- Malignant LVH (HR: 4.13) and isolated LVH (HR: 1.82) significantly increased AF risk compared to no LVH.
Conclusions:
- AF incidence risk varies significantly across LVH phenotypes.
- Malignant LVH presents the highest risk for incident AF.
- Incorporating LVH phenotypes enhances the predictive accuracy of AF risk models like CHARGE-AF.
Background And Aim:
Left ventricular hypertrophy (LVH) has been shown to be associated with the occurrence of atrial fibrillation (AF). However, the predictive value of the LVH phenotype for incident AF remains uncertain. This study aimed to investigate the predictive value of LVH phenotype for incident AF.
Methods And Results:
This study utilized the Multi-Ethnic Study of Atherosclerosis (MESA) data. LVH was defined by cardiac magnetic resonance measured LV mass index. Isolated LVH was determined as LVH without elevated cardiac biomarker and malignant LVH was determined as LVH with at least 1 elevated biomarker. Receiver-operating characteristic (ROC) analysis was performed to calculate areas under the curves (AUC) for predicting AF. A total of 4983 community-dwelling participants were included, with a mean age of 61.5 years. 279 (5.6 %) had isolated LVH, and 222 (4.5 %) had malignant LVH. During a median follow-up of 8.5 years, 272 incident AF was observed. Compared to participants without LVH and elevated cardiac biomarkers, those with isolated LVH (HR, 1.82; 95 % CI, 1.03-3.20) and malignant LVH (HR, 4.13; 95 % CI, 2.77-6.16) had a higher risk of incident AF. Malignant LVH carried a 1.5-fold increased risk of AF compared to isolated LVH (HR: 2.48, 95 % CI: 1.30-4.73). Including the LVH phenotype in the CHARGE-AF model improved model discrimination (AUC increase: 0.03, p < 0.001).
Conclusions:
The risks of AF incidence varied across LVH phenotypes. Malignant LVH carried the highest risk among LVH phenotypes. LVH phenotype provides incremental predictive value over the variables included in the CHARGE-AF model.
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