钙化冠状动脉斑块密度与心房颤动事件风险(来自动脉粥样硬化多民族研究)。

Density of Calcified Coronary Artery Plaque and Risk of Incident Atrial Fibrillation (from the Multiethnic Study of Atherosclerosis).

机构信息

Division of Cardiology, Department of Medicine and University of California, La Jolla, San Diego, California.

Department of Biostatistics, University of Washington, Seattle, Washington.

出版信息

Am J Cardiol. 2022 Sep 15;179:39-45. doi: 10.1016/j.amjcard.2022.06.012. Epub 2022 Jul 15.

Abstract

Elevated coronary artery calcium (CAC) score, as assessed by the Agatston method, is associated with incident atrial fibrillation (AF). We aimed to evaluate the associations of CAC volume and density with incident AF. Participants from the Multiethnic Study of Atherosclerosis without baseline AF and CAC >0 were included. The associations between baseline and progression (average annual change) of CAC measures and incident AF were evaluated using Cox proportional hazards models. CAC volume and Agatston scores were natural log (ln)-transformed, and hazard ratios (HRs) were calculated per standard deviation increment. The baseline analysis included 3,332 participants; 2,643 were included in the progression analysis. In multivariable models adjusted for cardiovascular risk factors, volume (HR 1.24, 95% confidence interval [CI] 1.14 to 1.36), density (HR 1.14, 95% CI 1.05 to 1.25), and Agatston score (HR 1.24, 95% CI 1.14 to 1.35) were associated with increased risk of incident AF. In models including both volume and density, the magnitude of association between volume and incident AF was unchanged, whereas the density association was eliminated (HR 0.99, 95% CI 0.89 to 1.11). Median time to follow-up CAC assessment was 1.9 (interquartile range 1.3, 3.0) years. Similar results were observed for the association of incident AF with annual change in volume and Agatston score. CAC volume, but not density, is associated with risk for incident AF when adjusting for both. In conclusion, our findings suggest that, although CAC may be a risk marker for AF, the association between CAC and AF appears to be independent of plaque density.

摘要

冠状动脉钙(CAC)评分升高(采用 Agatston 方法评估)与房颤(AF)的发生有关。我们旨在评估 CAC 容积和密度与房颤发生的相关性。纳入无基线房颤和 CAC >0 的动脉粥样硬化多民族研究参与者。使用 Cox 比例风险模型评估基线和进展(平均年度变化)CAC 测量值与房颤发生的相关性。CAC 容积和 Agatston 评分进行自然对数(ln)转换,每标准偏差增加计算风险比(HR)。基线分析包括 3332 名参与者;2643 名参与者纳入进展分析。在调整心血管危险因素的多变量模型中,容积(HR 1.24,95%置信区间 [CI] 1.14 至 1.36)、密度(HR 1.14,95% CI 1.05 至 1.25)和 Agatston 评分(HR 1.24,95% CI 1.14 至 1.35)与房颤发生风险增加相关。在包括容积和密度的模型中,容积与房颤发生的相关性大小保持不变,而密度相关性被消除(HR 0.99,95% CI 0.89 至 1.11)。随访 CAC 评估的中位时间为 1.9 年(四分位间距 1.3 至 3.0)。在容积和 Agatston 评分的年度变化与房颤发生的相关性中也观察到了类似的结果。在校正两者后,CAC 容积与房颤发生风险相关,而 CAC 密度则不相关。总之,我们的研究结果表明,尽管 CAC 可能是房颤的风险标志物,但 CAC 与房颤之间的相关性似乎独立于斑块密度。

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