Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street/Blalock 524, Baltimore, MD, USA.
Department of Medicine, Division of Cardiology, National Heart, Lung and Blood Institute, Bethesda, MD, USA.
Eur Heart J Cardiovasc Imaging. 2019 Sep 1;20(9):979-987. doi: 10.1093/ehjci/jez176.
Longitudinal change in left atrial (LA) structure and function could be helpful in predicting risk for incident atrial fibrillation (AF). We used cardiac magnetic resonance (CMR) imaging to explore the relationship between change in LA structure and function and incident AF in a multi-ethnic population free of clinical cardiovascular disease at baseline.
In the Multi-Ethnic Study of Atherosclerosis (MESA), 2338 participants, free at baseline of clinically recognized AF and cardiovascular disease, had LA volume and function assessed with CMR imaging, at baseline (2000-02), and at Exam 4 (2005-07) or 5 (2010-12). Free of AF, 124 participants developed AF over 3.8 ± 0.9 years (2015) following the second imaging. In adjusted Cox regression models, an average annualized change in all LA parameters were significantly associated with an increased risk of AF. An annual decrease of 1-SD unit in total LA emptying fractions (LAEF) was most strongly associated with risk of AF after adjusting for clinical risk factors for AF, baseline LA parameters, and left ventricular mass-to-volume ratio (hazard ratio per SD = 1.91, 95% confidence interval = 1.53-2.38, P < 0.001). The addition of change in total LAEF to an AF risk score improved model discrimination and reclassification (net reclassification improvement = 0.107, P = 0.017; integrative discrimination index = 0.049, P < 0.001).
In this multi-ethnic study population free of clinical cardiovascular disease at baseline, a greater increase in LA volumes and decrease in LA function were associated with incident AF. The addition of change in total LAEF to risk prediction models for AF improved model discrimination and reclassification of AF risk.
左心房（LA）结构和功能的纵向变化有助于预测房颤（AF）的发生风险。我们使用心脏磁共振（CMR）成像来探讨在基线时无临床心血管疾病的多民族人群中，LA 结构和功能变化与 AF 发生之间的关系。
在动脉粥样硬化多民族研究（MESA）中，2338 名参与者在基线时无临床公认的 AF 和心血管疾病，使用 CMR 成像评估 LA 容积和功能，基线时（2000-02 年）和检查 4 时（2005-07 年）或检查 5 时（2010-12 年）。在无 AF 的情况下，124 名参与者在第二次成像后 3.8±0.9 年（2015 年）发生 AF。在调整后的 Cox 回归模型中，所有 LA 参数的平均年化变化与 AF 风险增加显著相关。在调整 AF 的临床危险因素、基线 LA 参数和左心室质量与容积比后，总 LA 排空分数（LAEF）的 1-SD 单位每年下降与 AF 风险相关性最强（每 SD 危险比=1.91，95%置信区间 1.53-2.38，P<0.001）。将总 LAEF 的变化加入 AF 风险评分可提高模型的区分度和重新分类（净重新分类改善=0.107，P=0.017；综合判别指数=0.049，P<0.001）。
在这个基线时无临床心血管疾病的多民族研究人群中，LA 容积增加和 LA 功能下降与 AF 发生相关。将总 LAEF 的变化加入 AF 风险预测模型可提高 AF 风险的模型区分度和重新分类。
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