National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.
Department of Biochemistry, Medical College, Jiaxing University, Jiaxing, China.
Nutr Metab Cardiovasc Dis. 2024 Jun;34(6):1399-1406. doi: 10.1016/j.numecd.2024.01.012. Epub 2024 Jan 12.
Left ventricular hypertrophy (LVH) has been shown to be associated with the occurrence of atrial fibrillation (AF). However, the predictive value of the LVH phenotype for incident AF remains uncertain. This study aimed to investigate the predictive value of LVH phenotype for incident AF.
This study utilized the Multi-Ethnic Study of Atherosclerosis (MESA) data. LVH was defined by cardiac magnetic resonance measured LV mass index. Isolated LVH was determined as LVH without elevated cardiac biomarker and malignant LVH was determined as LVH with at least 1 elevated biomarker. Receiver-operating characteristic (ROC) analysis was performed to calculate areas under the curves (AUC) for predicting AF. A total of 4983 community-dwelling participants were included, with a mean age of 61.5 years. 279 (5.6 %) had isolated LVH, and 222 (4.5 %) had malignant LVH. During a median follow-up of 8.5 years, 272 incident AF was observed. Compared to participants without LVH and elevated cardiac biomarkers, those with isolated LVH (HR, 1.82; 95 % CI, 1.03-3.20) and malignant LVH (HR, 4.13; 95 % CI, 2.77-6.16) had a higher risk of incident AF. Malignant LVH carried a 1.5-fold increased risk of AF compared to isolated LVH (HR: 2.48, 95 % CI: 1.30-4.73). Including the LVH phenotype in the CHARGE-AF model improved model discrimination (AUC increase: 0.03, p < 0.001).
The risks of AF incidence varied across LVH phenotypes. Malignant LVH carried the highest risk among LVH phenotypes. LVH phenotype provides incremental predictive value over the variables included in the CHARGE-AF model.
左心室肥厚（LVH）与心房颤动（AF）的发生有关。然而，LVH 表型对 AF 事件的预测价值尚不确定。本研究旨在探讨 LVH 表型对 AF 事件的预测价值。
本研究利用多民族动脉粥样硬化研究（MESA）的数据。LVH 通过心脏磁共振测量的左心室质量指数来定义。孤立性 LVH 定义为无升高的心脏标志物的 LVH，恶性 LVH 定义为至少有 1 个升高标志物的 LVH。进行接受者操作特征（ROC）分析，以计算预测 AF 的曲线下面积（AUC）。共纳入 4983 名社区居住的参与者，平均年龄为 61.5 岁。279 名（5.6%）患有孤立性 LVH，222 名（4.5%）患有恶性 LVH。在中位数为 8.5 年的随访期间，观察到 272 例新发 AF。与无 LVH 和升高的心脏标志物的参与者相比，孤立性 LVH （HR，1.82；95%CI，1.03-3.20）和恶性 LVH （HR，4.13；95%CI，2.77-6.16）发生新发 AF 的风险更高。恶性 LVH 比孤立性 LVH 发生 AF 的风险增加 1.5 倍（HR：2.48，95%CI：1.30-4.73）。在 CHARGE-AF 模型中加入 LVH 表型可提高模型区分度（AUC 增加：0.03，p<0.001）。
AF 发病风险在不同的 LVH 表型中有所不同。恶性 LVH 在 LVH 表型中风险最高。LVH 表型提供了 CHARGE-AF 模型中包含的变量之外的增量预测价值。
