title: Left Ventricular Systolic Dysfunction by Longitudinal Strain Is an Independent Predictor of Incident Atrial Fibrillation: A Community-Based Cohort Study.
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.
  
  
  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.
authors.affiliation: From the Division of Cardiology, Department of Medicine (C.R., F.S., E.S.L., S.H., M.R.D.T.), Department of Biostatistics (Z.J.), and Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurology (T.R., R.L.S.), Department of Epidemiology and Public Health (T.R., R.L.S.), and Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL. cr2321@cumc.columbia.edu.
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.affiliation: From the Division of Cardiology, Department of Medicine (C.R., F.S., E.S.L., S.H., M.R.D.T.), Department of Biostatistics (Z.J.), and Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurology (T.R., R.L.S.), Department of Epidemiology and Public Health (T.R., R.L.S.), and Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL.
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.affiliation: From the Division of Cardiology, Department of Medicine (C.R., F.S., E.S.L., S.H., M.R.D.T.), Department of Biostatistics (Z.J.), and Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurology (T.R., R.L.S.), Department of Epidemiology and Public Health (T.R., R.L.S.), and Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL.
authors.forename: Fusako
authors.initials: F
authors.lastname: Sera
authors.affiliation: From the Division of Cardiology, Department of Medicine (C.R., F.S., E.S.L., S.H., M.R.D.T.), Department of Biostatistics (Z.J.), and Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurology (T.R., R.L.S.), Department of Epidemiology and Public Health (T.R., R.L.S.), and Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Lee
authors.affiliation: From the Division of Cardiology, Department of Medicine (C.R., F.S., E.S.L., S.H., M.R.D.T.), Department of Biostatistics (Z.J.), and Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurology (T.R., R.L.S.), Department of Epidemiology and Public Health (T.R., R.L.S.), and Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.affiliation: From the Division of Cardiology, Department of Medicine (C.R., F.S., E.S.L., S.H., M.R.D.T.), Department of Biostatistics (Z.J.), and Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurology (T.R., R.L.S.), Department of Epidemiology and Public Health (T.R., R.L.S.), and Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.affiliation: From the Division of Cardiology, Department of Medicine (C.R., F.S., E.S.L., S.H., M.R.D.T.), Department of Biostatistics (Z.J.), and Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurology (T.R., R.L.S.), Department of Epidemiology and Public Health (T.R., R.L.S.), and Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL.
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: From the Division of Cardiology, Department of Medicine (C.R., F.S., E.S.L., S.H., M.R.D.T.), Department of Biostatistics (Z.J.), and Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurology (T.R., R.L.S.), Department of Epidemiology and Public Health (T.R., R.L.S.), and Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: From the Division of Cardiology, Department of Medicine (C.R., F.S., E.S.L., S.H., M.R.D.T.), Department of Biostatistics (Z.J.), and Departments of Neurology and Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurology (T.R., R.L.S.), Department of Epidemiology and Public Health (T.R., R.L.S.), and Department of Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D001696:Biomechanical Phenomena; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009519:New York City / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: atrial fibrillation; echocardiography; systole; ventricular dysfunction, left