Department of Medicine, Division of Cardiology, Emory University of School of Medicine, 101 Woodruff Circle, Woodruff Memorial Building, Atlanta, GA 30322, USA.
Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA.
Eur Heart J Cardiovasc Imaging. 2018 Mar 1;19(3):279-284. doi: 10.1093/ehjci/jex093.
To determine if progression of mitral annular calcium (MAC) detected by cardiac computed tomography (CT) predicts incident atrial fibrillation (AF).
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).
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.
通过心脏计算机断层扫描（CT）确定二尖瓣环钙（MAC）的进展是否可预测房颤（AF）的发生。
本分析纳入了来自动脉粥样硬化多民族研究（Multi-Ethnic Study of Atherosclerosis）的 5683 名参与者（平均年龄 64±10 岁；52%为女性；40%为白人；27%为黑人；21%为西班牙裔；12%为华裔美国人）。基线时和平均随访 2.4±0.84 年时的心脏 CT 检测 MAC。通过回顾医院出院记录和 2012 年 12 月 31 日之前的医疗保险索赔数据确定 AF。Cox 回归用于计算 MAC 进展与 AF 之间的关联的风险比（HR）和 95%置信区间（CI）。在中位随访 8.6 年期间，共发现 533 例（9.4%）新发 AF 病例。在调整年龄、性别、种族/民族、教育、收入、基线 MAC、收缩压、体重指数、糖尿病、吸烟、总胆固醇、高密度脂蛋白胆固醇、降压药物、降脂治疗和阿司匹林后，任何 MAC 进展（>0/年）均与 AF 风险增加相关（HR=1.50，95%CI=1.20-1.87）。MAC 进展与 AF 之间的年龄（<65 岁与年龄较大）、性别或种族/民族（白人与非白人）之间没有显著的乘法相互作用。
通过随访 MAC 测量获得了有关 AF 风险的重要预后信息，因为任何 MAC 进展的参与者的风险明显大于无进展的参与者。MAC 进展可能检测到易患 AF 的潜在左心房异常。
