title: Left atrial size and function as predictors of new-onset of atrial fibrillation in patients with asymptomatic aortic stenosis: the simvastatin and ezetimibe in aortic stenosis study.
abstract: BACKGROUND
  Left atrial (LA) size and function change with chronically increased left ventricular (LV) filling pressures. It remains unclear whether these variations in LA parameters can predict new-onset atrial fibrillation (AF) in asymptomatic patients with aortic stenosis (AS).
  
  
  METHODS
  Data were obtained in asymptomatic patients with mild-to-moderate AS (2.5 ≤ transaortic Doppler velocity ≤ 4.0m/s), preserved LV ejection fraction (EF), no previous AF, and were enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study. Peak-aortic velocity, LA(max) volume & LAmin volume were measured by echocardiography. LA conduit (LA(con)) volume was defined as LV stroke volume-LA stroke volume. LA function was expressed as LA-EF (LA(max)-LAmin volume/LA(max)).
  
  
  RESULTS
  In the 1159 patients included, new-onset AF occurred in 71 patients (6.1%) within a mean follow-up of 4.2 ± 0.9 years. Mean age was 66 ± 9.7 years, aortic valve area index 0.6 ± 0.2 cm(2)/m(2), LV mass 99.2 ± 29.7 g/m(2), LA(max) volume 34.6 ± 12.0 mL/m(2), LAmin volume 17.9 ± 9.3 mL/m(2), LA-EF 50 ± 15% and LA(con) volume 45 ± 21 mL/m(2). Baseline LAmin volume predicted new-onset AF in Cox multivariable analysis (HR:2.3 [95%CI:1.3-4.4], P<0.01), and added prognostic information on AF development beyond conventional risk factors (likelihood ratio, P<0.01). In comparison of c-indexes LAmin volume was superior to all other LA measurements. Net reclassification index improved by 15.9% when adding LAmin volume to a model with classic risk factors for AF (P=0.01).
  
  
  CONCLUSIONS
  LAmin volume independently predicted new-onset AF in patients with asymptomatic AS and was superior to LA-EF, LA(con) and LA(max) volumes and conventional risk factors.
authors: Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen Denmark. Electronic address: casperbang@hotmail.com.
authors: Casper N
authors: CN
authors: Bang
authors: Morten
authors: M
authors: Dalsgaard
authors: Anders M
authors: AM
authors: Greve
authors: Lars
authors: L
authors: Køber
authors: Christa
authors: C
authors: Gohlke-Baerwolf
authors: Simon
authors: S
authors: Ray
authors: Anne B
authors: AB
authors: Rossebø
authors: Kenneth
authors: K
authors: Egstrup
authors: Kristian
authors: K
authors: Wachtell
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016279:Atrial Function, Left; D001384:Azetidines / Q000008:administration & dosage*; D001783:Blood Flow Velocity; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D015150:Echocardiography, Doppler / Q000379:methods*; D004562:Electrocardiography; D000069438:Ezetimibe; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019821:Simvastatin / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin; D000069438:Ezetimibe
keywords: Aortic stenosis; Atrial fibrillation; Echocardiography; Left atrial volume