Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study.
- 1 February 1994
- journal article
- abstracts
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 89 (2), 724-730
- https://doi.org/10.1161/01.cir.89.2.724
Abstract
BACKGROUND Although structural heart disease is often present in patients with nonrheumatic atrial fibrillation, the echocardiographic precursors of atrial fibrillation have not been reported previously. In this elderly, population-based cohort, our objective was to examine prospectively the echocardiographic predictors of nonrheumatic atrial fibrillation. METHODS AND RESULTS Subjects in the Framingham Heart Study were routinely evaluated with M-mode echocardiography; 1924 subjects, ranging in age from 59 to 90 years, comprised the population at risk. Cox proportional hazards modeling was used to analyze the association of selected echocardiographic features with atrial fibrillation risk after adjustment for age, sex, hypertension, coronary heart disease, congestive heart failure, diabetes, and valvular heart disease. During a mean follow-up interval of 7.2 years, 154 subjects (8.0%) developed atrial fibrillation. Multivariable stepwise analysis identified left atrial size (hazard ratio [HR] per 5-mm increment, 1.39; 95% confidence interval [CI], 1.14 to 1.68), left ventricular fractional shortening (HR per 5% decrement, 1.34; 95% CI, 1.08 to 1.66), and sum of septal and left ventricular posterior wall thickness (HR per 4-mm increment, 1.28; 95% CI, 1.03 to 1.60) as independent echocardiographic predictors of atrial fibrillation. For each of the echocardiographic predictors, risk increased progressively over successive quartiles. Moreover, risk increased markedly when highest-risk-quartile measurements for these features were present in combination; the cumulative 8-year age-adjusted atrial fibrillation rates were 7.3% and 17.0%, respectively, when one and two or more highest-risk-quartile features were present, compared with 3.7% when none was present. CONCLUSIONS In this elderly, population-based sample, left atrial enlargement, increased left ventricular wall thickness, and reduced left ventricular fractional shortening were predictive of risk for nonrheumatic atrial fibrillation. These echocardiographic precursors offer prognostic information beyond that provided by traditional clinical atrial fibrillation risk factors.This publication has 28 references indexed in Scilit:
- Risk for systemic embolization of atrial fibrillation without mitral stenosisThe American Journal of Cardiology, 1990
- Left atrial enlargement: An early sign of hypertensive heart diseaseAmerican Heart Journal, 1988
- Atrial fibrillation and atrial enlargement in patients with mitral stenosisAmerican Heart Journal, 1987
- Relation between left atrial dimension and duration of atrial fibrillationThe American Journal of Cardiology, 1987
- Echocardiographic criteria for left ventricular hypertrophy: The Framingham heart studyThe American Journal of Cardiology, 1987
- Detection of ischemic wall dysfunction: Comparison between M-mode echocardiography and sonomicrometryAmerican Heart Journal, 1984
- Epidemiologic Features of Chronic Atrial FibrillationThe New England Journal of Medicine, 1982
- Left atrial enlargement in patients with paroxysmal atrial fibrillation.Japanese Heart Journal, 1982
- Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements.Circulation, 1978
- Pathophysiologic assessment of hypertensive heart disease with echocardiographyThe American Journal of Cardiology, 1977