Wesley T O'Neal1, Jimmy T Efird2, Saman Nazarian3, Alvaro Alonso4, Erin D Michos5, Moses Szklo6, Susan R Heckbert7, Elsayed Z Soliman8,9. 1. Department of Medicine, Division of Cardiology, Emory University of School of Medicine, 101 Woodruff Circle, Woodruff Memorial Building, Atlanta, GA 30322, USA. 2. Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA. 3. Department of Medicine, Division of Cardiology, University of Pennsylvania School of Medicine, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA. 4. Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA. 5. Department of Medicine, Division of Cardiology, and The Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA. 6. Department of Epidemiology, Bloomberg School of Public Health, John Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA. 7. Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, 1730 Minor Ave, Seattle, WA 98101, USA. 8. Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA. 9. Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
Abstract
Aims: To determine if progression of mitral annular calcium (MAC) detected by cardiac computed tomography (CT) predicts incident atrial fibrillation (AF). Methods and results: This analysis included 5683 participants (mean age 64 ± 10 years; 52% women; 40% whites; 27% blacks; 21% Hispanics; 12% Chinese-Americans) from the Multi-Ethnic Study of Atherosclerosis. MAC was measured by cardiac CT at baseline and at a follow-up CT scan over a mean time of 2.4 ± 0.84 years. AF was ascertained by review of hospital discharge records and from Medicare claims data through 31 December 2012. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between MAC progression and AF. Over a median follow-up of 8.6 years, a total of 533 (9.4%) incident AF cases were detected. In a model adjusted for age, sex, race/ethnicity, education, income, baseline MAC, systolic blood pressure, body mass index, diabetes, smoking, total cholesterol, high-density lipoprotein cholesterol, antihypertensive medications, lipid-lowering therapies, and aspirin, any MAC progression (>0/year) was associated with an increased risk for AF (HR = 1.50, 95% CI = 1.20-1.87). Multiplicative interactions were not significant between MAC progression and AF by age (<65 year vs. older), sex, or race/ethnicity (whites vs. non-whites). Conclusion: Important prognostic information regarding AF risk is obtained with follow-up MAC measurement, as the risk for participants with any MAC progression was substantively greater than participants without progression. MAC progression may detect underlying left atrial abnormalities that predispose to AF. Published on behalf of the European Society of Cardiology. All rights reserved.
Aims: To determine if progression of mitral annular calcium (MAC) detected by cardiac computed tomography (CT) predicts incident atrial fibrillation (AF). Methods and results: This analysis included 5683 participants (mean age 64 ± 10 years; 52% women; 40% whites; 27% blacks; 21% Hispanics; 12% Chinese-Americans) from the Multi-Ethnic Study of Atherosclerosis. MAC was measured by cardiac CT at baseline and at a follow-up CT scan over a mean time of 2.4 ± 0.84 years. AF was ascertained by review of hospital discharge records and from Medicare claims data through 31 December 2012. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between MAC progression and AF. Over a median follow-up of 8.6 years, a total of 533 (9.4%) incident AF cases were detected. In a model adjusted for age, sex, race/ethnicity, education, income, baseline MAC, systolic blood pressure, body mass index, diabetes, smoking, total cholesterol, high-density lipoprotein cholesterol, antihypertensive medications, lipid-lowering therapies, and aspirin, any MAC progression (>0/year) was associated with an increased risk for AF (HR = 1.50, 95% CI = 1.20-1.87). Multiplicative interactions were not significant between MAC progression and AF by age (<65 year vs. older), sex, or race/ethnicity (whites vs. non-whites). Conclusion: Important prognostic information regarding AF risk is obtained with follow-up MAC measurement, as the risk for participants with any MAC progression was substantively greater than participants without progression. MAC progression may detect underlying left atrial abnormalities that predispose to AF. Published on behalf of the European Society of Cardiology. All rights reserved.
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