Left ventricular systolic dysfunction by longitudinal strain is an independent predictor of incident atrial fibrillation: A community-based cohort study

Cesare Russo, Zhezhen Jin, Fusako Sera, Edward S. Lee, Shunichi Homma, Tatjana Rundek, Mitchell S V Elkind, Ralph L Sacco, Marco R. Di Tullio

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background - The increasing prevalence of atrial fibrillation (AF) represents a public health issue. Identifying new predictors of AF is therefore necessary to plan preventive strategies. We investigated whether left ventricular (LV) systolic dysfunction by global longitudinal strain (GLS), a predictor of cardiovascular events, may predict new-onset AF in a population setting. Methods and Results - Participants (n=675; mean age, 71±9 years; 60% women) in sinus rhythm from the population-based Northern Manhattan Study (NOMAS) underwent 2- and 3-dimensional echocardiography as part of the Cardiac Abnormalities and Brain Lesions (CABL) study. LV systolic function was assessed by LV ejection fraction and speckle-tracking GLS. During a mean follow-up of 63.6±18.7 months, 32 (4.7%) new confirmed cases of AF occurred. Lower GLS (adjusted hazard ratio/unit decrease, 1.22; 95% confidence interval, 1.04-1.43; P=0.015) and increased left atrial volume index (LAVi; adjusted hazard ratio/unit increase, 1.12; 95% confidence interval, 1.07-1.17; P<0.001) were significantly associated with incident AF, whereas LV ejection fraction was not (P=0.176). Abnormal GLS (>-14.7%) was associated with risk of new-onset AF with an adjusted hazard ratio of 3.2 (95% confidence interval, 1.4-7.5; P=0.007). The coexistence of abnormal GLS/abnormal LAVi was associated with a 28.6% incidence of AF (adjusted hazard ratio, 12.1; 95% confidence interval, 3.3-44.8; P<0.001) compared with participants with normal GLS/normal LAVi (AF incidence, 2.0%). AF incidence was intermediate in those with either abnormal GLS or abnormal LAVi (9.3% and 11.1%, respectively). GLS prognostic value for incident AF was incremental over risk factors and LAVi. Conclusions - LV systolic dysfunction by GLS was a powerful and independent predictor of incident AF. GLS assessment may improve AF risk stratification in addition to established parameters.

Original languageEnglish (US)
JournalCirculation: Cardiovascular Imaging
Volume8
Issue number8
DOIs
StatePublished - Aug 1 2015

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Left Ventricular Dysfunction
Atrial Fibrillation
Cohort Studies
Confidence Intervals
Incidence
Left Ventricular Function
Stroke Volume
Population
Echocardiography
Public Health

Keywords

  • atrial fibrillation
  • echocardiography
  • systole
  • ventricular dysfunction, left

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Left ventricular systolic dysfunction by longitudinal strain is an independent predictor of incident atrial fibrillation : A community-based cohort study. / Russo, Cesare; Jin, Zhezhen; Sera, Fusako; Lee, Edward S.; Homma, Shunichi; Rundek, Tatjana; Elkind, Mitchell S V; Sacco, Ralph L; Di Tullio, Marco R.

In: Circulation: Cardiovascular Imaging, Vol. 8, No. 8, 01.08.2015.

Research output: Contribution to journalArticle

Russo, Cesare ; Jin, Zhezhen ; Sera, Fusako ; Lee, Edward S. ; Homma, Shunichi ; Rundek, Tatjana ; Elkind, Mitchell S V ; Sacco, Ralph L ; Di Tullio, Marco R. / Left ventricular systolic dysfunction by longitudinal strain is an independent predictor of incident atrial fibrillation : A community-based cohort study. In: Circulation: Cardiovascular Imaging. 2015 ; Vol. 8, No. 8.
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abstract = "Background - The increasing prevalence of atrial fibrillation (AF) represents a public health issue. Identifying new predictors of AF is therefore necessary to plan preventive strategies. We investigated whether left ventricular (LV) systolic dysfunction by global longitudinal strain (GLS), a predictor of cardiovascular events, may predict new-onset AF in a population setting. Methods and Results - Participants (n=675; mean age, 71±9 years; 60{\%} women) in sinus rhythm from the population-based Northern Manhattan Study (NOMAS) underwent 2- and 3-dimensional echocardiography as part of the Cardiac Abnormalities and Brain Lesions (CABL) study. LV systolic function was assessed by LV ejection fraction and speckle-tracking GLS. During a mean follow-up of 63.6±18.7 months, 32 (4.7{\%}) new confirmed cases of AF occurred. Lower GLS (adjusted hazard ratio/unit decrease, 1.22; 95{\%} confidence interval, 1.04-1.43; P=0.015) and increased left atrial volume index (LAVi; adjusted hazard ratio/unit increase, 1.12; 95{\%} confidence interval, 1.07-1.17; P<0.001) were significantly associated with incident AF, whereas LV ejection fraction was not (P=0.176). Abnormal GLS (>-14.7{\%}) was associated with risk of new-onset AF with an adjusted hazard ratio of 3.2 (95{\%} confidence interval, 1.4-7.5; P=0.007). The coexistence of abnormal GLS/abnormal LAVi was associated with a 28.6{\%} incidence of AF (adjusted hazard ratio, 12.1; 95{\%} confidence interval, 3.3-44.8; P<0.001) compared with participants with normal GLS/normal LAVi (AF incidence, 2.0{\%}). AF incidence was intermediate in those with either abnormal GLS or abnormal LAVi (9.3{\%} and 11.1{\%}, respectively). GLS prognostic value for incident AF was incremental over risk factors and LAVi. Conclusions - LV systolic dysfunction by GLS was a powerful and independent predictor of incident AF. GLS assessment may improve AF risk stratification in addition to established parameters.",
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T2 - A community-based cohort study

AU - Russo, Cesare

AU - Jin, Zhezhen

AU - Sera, Fusako

AU - Lee, Edward S.

AU - Homma, Shunichi

AU - Rundek, Tatjana

AU - Elkind, Mitchell S V

AU - Sacco, Ralph L

AU - Di Tullio, Marco R.

PY - 2015/8/1

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N2 - Background - The increasing prevalence of atrial fibrillation (AF) represents a public health issue. Identifying new predictors of AF is therefore necessary to plan preventive strategies. We investigated whether left ventricular (LV) systolic dysfunction by global longitudinal strain (GLS), a predictor of cardiovascular events, may predict new-onset AF in a population setting. Methods and Results - Participants (n=675; mean age, 71±9 years; 60% women) in sinus rhythm from the population-based Northern Manhattan Study (NOMAS) underwent 2- and 3-dimensional echocardiography as part of the Cardiac Abnormalities and Brain Lesions (CABL) study. LV systolic function was assessed by LV ejection fraction and speckle-tracking GLS. During a mean follow-up of 63.6±18.7 months, 32 (4.7%) new confirmed cases of AF occurred. Lower GLS (adjusted hazard ratio/unit decrease, 1.22; 95% confidence interval, 1.04-1.43; P=0.015) and increased left atrial volume index (LAVi; adjusted hazard ratio/unit increase, 1.12; 95% confidence interval, 1.07-1.17; P<0.001) were significantly associated with incident AF, whereas LV ejection fraction was not (P=0.176). Abnormal GLS (>-14.7%) was associated with risk of new-onset AF with an adjusted hazard ratio of 3.2 (95% confidence interval, 1.4-7.5; P=0.007). The coexistence of abnormal GLS/abnormal LAVi was associated with a 28.6% incidence of AF (adjusted hazard ratio, 12.1; 95% confidence interval, 3.3-44.8; P<0.001) compared with participants with normal GLS/normal LAVi (AF incidence, 2.0%). AF incidence was intermediate in those with either abnormal GLS or abnormal LAVi (9.3% and 11.1%, respectively). GLS prognostic value for incident AF was incremental over risk factors and LAVi. Conclusions - LV systolic dysfunction by GLS was a powerful and independent predictor of incident AF. GLS assessment may improve AF risk stratification in addition to established parameters.

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