From the Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-0409 (T.P., B.A.V., T.Q., Y.K., H.D.d.V., C.O.W., W.S.P., J.A.C.L.); Department of Cardiology, Lariboisière Hospital-APHP, Inserm UMRS 942, University of Paris, Paris, France (T.P., P.H.); Department of Epidemiology, University of Washington, Seattle, Wash (S.R.H.); and University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.A.C.L.).
Radiology. 2022 May;303(2):317-326. doi: 10.1148/radiol.210315. Epub 2022 Feb 22.
Background Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF). Purpose To investigate the prognostic value of a left atrioventricular coupling index (LACI) and average annualized change in LACI (hereafter, ΔLACI) measured by cardiac MRI to predict incident AF in a population-based sample from the Multi-Ethnic Study of Atherosclerosis (MESA). Materials and Methods In a secondary analysis of the prospective MESA, 1911 study participants without clinically recognized AF and cardiovascular disease at baseline had LACI assessed with cardiac MRI at baseline (examination 1, 2000-2002) and 10 years later (examination 5, 2010-2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average ΔLACI with incident AF. Results Among the 1911 participants (mean age, 59 years ± 9 [standard deviation]; 907 men), 87 incident AF events occurred over 3.9 years ± 0.9 after the second imaging (examination 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (hazard ratio, 1.69 [95% CI: 1.46, 1.96] and 1.71 [95% CI: 1.50, 1.94], respectively; both < .001). Adjusted models for LACI and ΔLACI showed improvement in model discrimination compared with currently used AF risk score (Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score) model (area under receiver operating characteristic curve [AUC], 0.78 vs 0.74; and AUC, 0.80 vs 0.74, respectively; both < .001); and to the final model including individual LA or LV parameters for predicting AF incidence (AUC, 0.78 vs 0.76; and AUC, 0.80 vs 0.78, respectively; both < .001). Conclusion Atrioventricular coupling (left atrioventricular coupling index [LACI]) and coupling change (annual change in LACI) were strong predictors for atrial fibrillation (AF) in a multiethnic population. Both had incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination compared with the Cohort for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation, or CHARGE-AF, score and to individual left atrial or left ventricular parameters. © RSNA, 2022 See also the editorial by Leiner in this issue.
左心房（LA）和左心室（LV）的结构和功能参数作为心房颤动（AF）的预测因子具有独立的预后价值。目的：通过心脏 MRI 测量左房室耦联指数（LACI）和 LACI 的平均年变化值（以下简称ΔLACI），探讨其对预测动脉粥样硬化多民族研究（MESA）中人群发生 AF 的预后价值。材料与方法：对前瞻性 MESA 的二次分析中，1911 例基线时无临床确诊的 AF 和心血管疾病的研究参与者，在基线（检查 1，2000-2002 年）和 10 年后（检查 5，2010-2012 年）进行心脏 MRI 评估 LACI。LACI 定义为 LA 与 LV 舒张末期容积之比。采用单变量和多变量 Cox 比例风险模型评估 LACI 和平均ΔLACI 与 AF 事件的相关性。结果：在 1911 例参与者（平均年龄，59 岁±9[标准差]；907 例男性）中，在第二次影像学检查（检查 5）后 3.9 年±0.9 时发生了 87 例 AF 事件。在调整了传统危险因素后，较大的 LACI 和ΔLACI 与 AF 独立相关（风险比，1.69[95%CI：1.46，1.96]和 1.71[95%CI：1.50，1.94]；均<0.001）。与目前使用的 AF 风险评分（基因组流行病学中心与心脏和衰老研究-心房颤动，或 CHARGE-AF 评分）模型相比，LACI 和ΔLACI 的调整模型显示出更好的模型区分度（接受者操作特征曲线下面积[AUROC]，0.78 比 0.74；和 AUC，0.80 比 0.74；均<0.001）；并且优于预测 AF 发生率的包含个体 LA 或 LV 参数的最终模型（AUROC，0.78 比 0.76；和 AUC，0.80 比 0.78；均<0.001）。结论：房室耦联（左房室耦联指数[LACI]）和耦联变化（LACI 的年变化值）是多民族人群中 AF 的有力预测指标。两者对预测 AF 均具有优于传统危险因素的预后价值，与 CHARGE-AF 评分和个体 LA 或 LV 参数相比，具有更好的区分度。
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