title: Association of electrocardiographic and imaging surrogates of left ventricular hypertrophy with incident atrial fibrillation: MESA (Multi-Ethnic Study of Atherosclerosis).
abstract: OBJECTIVE
  This study sought to examine the association between left ventricular hypertrophy (LVH), deﬁned by cardiac magnetic resonance (CMR) and electrocardiography (ECG), with incident atrial fibrillation (AF).
  
  
  BACKGROUND
  Previous studies of the association between AF and LVH were based primarily on echocardiographic measures of LVH.
  
  
  METHODS
  The MESA (Multi-Ethnic Study of Atherosclerosis) enrolled 4,942 participants free of clinically recognized cardiovascular disease. Incident AF was based on MESA-ascertained hospital-discharge International Classification of Diseases codes and Centers for Medicare and Medicaid Services inpatient hospital claims. CMR-LVH was defined as left ventricular mass ≥95th percentile of the MESA population distribution. Eleven ECG-LVH criteria were assessed. The association of LVH with incident AF was evaluated using multivariable Cox proportional hazards models adjusted for CVD risk factors.
  
  
  RESULTS
  During a median follow-up of 6.9 years, 214 incident AF events were documented. Participants with AF were more likely to be older, hypertensive, and overweight. The risk of AF was greater in participants with CMR-derived LVH (hazard ratio [HR]: 2.04, 95% confidence interval [CI]: 1.15 to 3.62). AF was associated with ECG-derived LVH measure of Sokolow-Lyon voltage product after adjusting for CMR-LVH (HR: 1.83, 95% CI: 1.06 to 3.14, p = 0.02). The associations with AF for CMR-LVH and Sokolow-Lyon voltage product were attenuated when adjusted for CMR left atrial volumes.
  
  
  CONCLUSIONS
  In a multiethnic cohort of participants without clinically detected cardiovascular disease, both CMR and ECG-derived LVH were associated with incident AF. ECG-LVH showed prognostic signiﬁcance independent of CMR-LVH. The association was attenuated when adjusted for CMR left atrial volumes.
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: chrispin@jhmi.edu.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chrispin
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Aditya
authors.initials: A
authors.lastname: Jain
authors.affiliation: Departments of Epidemiology and Prevention and Internal Medicine, Cardiology Section, Epidemiological Cardiology Research Center (EPICARE), Wake Forest University School of Medicine, Winston-Salem, North Carolina.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health Clinical Center and National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D004562:Electrocardiography; D005006:Ethnicity / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D015994:Incidence; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged
keywords: atrial fibrillation; cardiac magnetic resonance imaging; electrocardiography; left ventricular hypertrophy