Flemming J Olsen1, Rasmus Møgelvang2, Gorm B Jensen3, Jan S Jensen4, Tor Biering-Sørensen5. 1. Copenhagen City Heart Study, Copenhagen, Denmark; Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: flemming.j.olsen@gmail.com. 2. Copenhagen City Heart Study, Copenhagen, Denmark; Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. 3. Copenhagen City Heart Study, Copenhagen, Denmark. 4. Copenhagen City Heart Study, Copenhagen, Denmark; Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 5. Copenhagen City Heart Study, Copenhagen, Denmark; Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
OBJECTIVES: This study sought to investigate whether left atrial (LA) functional measures predict atrial fibrillation (AF) in the general population. BACKGROUND: Increasing evidence suggests LA functional measures are predictors of AF in several patient groups. METHODS: In a community-based cohort study, approximately 2,000 individuals underwent a transthoracic echocardiogram. Conventional echocardiographic measures and extended LA measures, including the minimal and maximal LA volumes (LAVmin and LAVmax, respectively) and left atrial emptying fraction (LAEF), were performed. The endpoint was incident AF, and participants with known AF were excluded, which left 1,951 for inclusion. RESULTS: Over 11.0 years of follow-up, 184 (9.4%) developed AF. Those who developed AF had significantly larger LA volumes and lower LAEF than participants free of AF. These LA measures were univariable predictors of AF (LAVmax hazard ratio [HR]: 1.10 [95% confidence interval (CI): 1.08 to 1.12] per 1-ml increase, p < 0.001; LAVmin HR: 1.14 [95% CI: 1.12 to 1.16] per 1-ml increase, p < 0.001; LAEF HR: 1.03 [95% CI: 1.02 to 1.04] per percent decrease, p < 0.001). All LA measures remained predictors independent of clinical risk scores, with LAVmin providing the highest C-statistics when added to these risk scores (C-statistic for CHADS2 0.728 vs. CHADS2 + LAVmin 0.778; C-statistic for CHARGE-AF 0.815 vs. CHARGE-AF + LAVmin 0.830). However, hypertension modified the relationship between the measures of LA function (both LAVmin and LAEF) and risk of AF (p for interaction < 0.001), which was not the case for LAVmax (p = 0.22). The measures of LA function mainly provided prognostic information regarding risk of AF in participants without hypertension. Even when we restricted our analysis to individuals without hypertension and nondilated LA (LAVmax<34 ml/m2), the LAVmin and LAEF remained significantly independent predictors of AF after multivariable adjustments (LAVmin HR: 1.12 [95% CI: 1.01 to 1.24], p = 0.028, and LAEF HR: 1.03 [95% CI: 1.00 to 1.06], p = 0.021, respectively). CONCLUSIONS: LA functional measures predict AF in the general population and provide prognostic information incremental to clinical risk scores. In individuals without hypertension and nondilated LA, these measures indicate an increased risk of AF.
OBJECTIVES: This study sought to investigate whether left atrial (LA) functional measures predict atrial fibrillation (AF) in the general population. BACKGROUND: Increasing evidence suggests LA functional measures are predictors of AF in several patient groups. METHODS: In a community-based cohort study, approximately 2,000 individuals underwent a transthoracic echocardiogram. Conventional echocardiographic measures and extended LA measures, including the minimal and maximal LA volumes (LAVmin and LAVmax, respectively) and left atrial emptying fraction (LAEF), were performed. The endpoint was incident AF, and participants with known AF were excluded, which left 1,951 for inclusion. RESULTS: Over 11.0 years of follow-up, 184 (9.4%) developed AF. Those who developed AF had significantly larger LA volumes and lower LAEF than participants free of AF. These LA measures were univariable predictors of AF (LAVmax hazard ratio [HR]: 1.10 [95% confidence interval (CI): 1.08 to 1.12] per 1-ml increase, p < 0.001; LAVmin HR: 1.14 [95% CI: 1.12 to 1.16] per 1-ml increase, p < 0.001; LAEF HR: 1.03 [95% CI: 1.02 to 1.04] per percent decrease, p < 0.001). All LA measures remained predictors independent of clinical risk scores, with LAVmin providing the highest C-statistics when added to these risk scores (C-statistic for CHADS2 0.728 vs. CHADS2 + LAVmin 0.778; C-statistic for CHARGE-AF 0.815 vs. CHARGE-AF + LAVmin 0.830). However, hypertension modified the relationship between the measures of LA function (both LAVmin and LAEF) and risk of AF (p for interaction < 0.001), which was not the case for LAVmax (p = 0.22). The measures of LA function mainly provided prognostic information regarding risk of AF in participants without hypertension. Even when we restricted our analysis to individuals without hypertension and nondilated LA (LAVmax<34 ml/m2), the LAVmin and LAEF remained significantly independent predictors of AF after multivariable adjustments (LAVmin HR: 1.12 [95% CI: 1.01 to 1.24], p = 0.028, and LAEF HR: 1.03 [95% CI: 1.00 to 1.06], p = 0.021, respectively). CONCLUSIONS: LA functional measures predict AF in the general population and provide prognostic information incremental to clinical risk scores. In individuals without hypertension and nondilated LA, these measures indicate an increased risk of AF.
Authors: Flemming J Olsen; Louisa M Christensen; Derk W Krieger; Søren Højberg; Nis Høst; Finn M Karlsen; Jesper H Svendsen; Hanne Christensen; Tor Biering-Sørensen Journal: Int J Cardiovasc Imaging Date: 2019-10-08 Impact factor: 2.357
Authors: Ditte Madsen Andersen; Morten Sengeløv; Flemming Javier Olsen; Jacob Louis Marott; Gorm Boje Jensen; Peter Schnohr; Elke Platz; Morten Schou; Rasmus Mogelvang; Tor Biering-Sørensen Journal: Eur J Heart Fail Date: 2022-01-05 Impact factor: 15.534
Authors: Flemming Javier Olsen; Sofie Reumert Biering-Sørensen; Anne Marie Reimer Jensen; Peter Schnohr; Gorm Boje Jensen; Jesper Hastrup Svendsen; Rasmus Møgelvang; Tor Biering-Sørensen Journal: Clin Res Cardiol Date: 2021-08-18 Impact factor: 5.460