Circulation, Vol 89, 724-730, Copyright © 1994 by American Heart Association
SM Vaziri, MG Larson, EJ Benjamin and D Levy
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.
ARTICLES
Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study
Framingham Heart Study, Mass 01701.
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