Bekwelem Wobo, Misialek Jeffrey R, Konety Suma, Solomon Scott D, Soliman Elsayed Z, Loehr Laura R, Lopez Faye L, Fox Ervin R, Mosley Thomas H, Alonso Alvaro
Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, United States of America.
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America.
PLoS One. 2014 Oct 16;9(10):e110111. doi: 10.1371/journal.pone.0110111. eCollection 2014.
Several studies have examined the link between atrial fibrillation (AF) and various echocardiographic measures of cardiac structure and function in whites and other racial groups but not in blacks. Exploring AF risk factors in blacks is important given that the lower incidence of AF in this racial group despite higher risk factors, is not completely explained.
We examined the association of echocardiographic measures with AF incidence in 2283 blacks (64.5% women, mean age 58.8 years) free of diagnosed AF and enrolled in the Jackson cohort of Atherosclerosis Risk in Communities (ARIC) study, a prospective study of cardiovascular disease. Echocardiography was performed in 1993-1995, and incident AF was determined by electrocardiograms at a follow-up study exam, hospitalization discharge codes and death certificates through the end of 2009. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals for AF associated with the echocardiographic measures, adjusting for age, sex, and known AF risk factors.
During an average follow-up of 13.5 years, 191 (8.4%) individuals developed AF. Left ventricular (LV) internal diameter 2-D (diastole) and percent fractional shortening of LV diameter displayed a U-shaped relationship with risk of AF, while left atrial diameter displayed a J-shaped nonlinear association. LV mass index was associated positively with AF. E/A ratio <0.7 or >1.5 and ejection fraction (EF <50%) were also associated with higher AF risk. These measures improved risk stratification for AF in addition to traditional risk factors, although not significantly {C-statistic of 0.767 (0.714-0.819) vs. 0.744 (0.691-0.797)}.
In a community-based population of blacks, echocardiographic measures of cardiac structure and function are significantly associated with an increased risk of AF.
多项研究探讨了心房颤动（AF）与白人和其他种族群体心脏结构和功能的各种超声心动图测量指标之间的联系，但未涉及黑人。鉴于该种族群体中AF发病率较低，尽管存在较高的风险因素，但这一现象尚未得到充分解释，因此探索黑人AF的危险因素具有重要意义。
我们在2283名未诊断出AF的黑人（64.5%为女性，平均年龄58.8岁）中研究了超声心动图测量指标与AF发病率之间的关联，这些黑人参加了社区动脉粥样硬化风险（ARIC）研究的杰克逊队列，这是一项心血管疾病的前瞻性研究。1993年至1995年进行了超声心动图检查，并通过随访研究检查的心电图、住院出院编码和截至2009年底的死亡证明来确定新发AF。采用Cox比例风险回归来估计与超声心动图测量指标相关的AF的风险比和95%置信区间，并对年龄、性别和已知的AF危险因素进行了调整。
在平均13.5年的随访期间，191人（8.4%）发生了AF。左心室（LV）二维内径（舒张期）和左心室直径缩短分数百分比与AF风险呈U形关系，而左心房直径呈J形非线性关联。左心室质量指数与AF呈正相关。E/A比值<0.7或>1.5以及射血分数（EF<50%）也与较高的AF风险相关。除了传统危险因素外，这些测量指标还改善了AF的风险分层，尽管改善并不显著{C统计量为0.767（0.714 - 0.819）vs. 0.744（0.691 - 0.797）}。
在以社区为基础的黑人人群中，心脏结构和功能的超声心动图测量指标与AF风险增加显著相关。
