title: Cardiac Magnetic Resonance-Measured Left Atrial Volume and Function and Incident Atrial Fibrillation: Results From MESA (Multi-Ethnic Study of Atherosclerosis).
abstract: BACKGROUND
  Early detection of structural changes in left atrium (LA) before atrial fibrillation (AF) development could be helpful in identification of those at higher risk for AF. Using cardiac magnetic resonance imaging, we examined the association of LA volume and function, and incident AF in a multiethnic population free of clinical cardiovascular diseases.
  
  
  RESULTS
  In a case-cohort study embedded in MESA (Multi-Ethnic Study of Atherosclerosis), baseline LA size and function assessed by cardiac magnetic resonance feature-tracking were compared between 197 participants with incident AF and 322 participants randomly selected from the whole MESA cohort. Participants were followed up for 8 years. Incident AF cases had a larger LA volume and decreased passive, active, and total LA emptying fractions and peak global LA longitudinal strain (peak LA strain) at baseline. In multivariable analysis, elevated LA maximum volume index (hazard ratio, 1.38 per SD; 95% confidence interval, 1.01-1.89) and decreased peak LA strain (hazard ratio, 0.68 per SD; 95% confidence interval, 0.48-0.96), and passive and total LA emptying fractions (hazard ratio for passive LA emptying fractions, 0.55 per SD; 95% confidence interval, 0.40-0.75 and hazard ratio for active LA emptying fractions, 0.70 per SD; 95% confidence interval, 0.52-0.95), but not active LA emptying fraction, were associated with incident AF.
  
  
  CONCLUSIONS
  Elevated LA volumes and decreased passive and total LA emptying fractions were independently associated with incident AF in an asymptomatic multiethnic population. Including LA functional variables along with other risk factors of AF may help to better risk stratify individuals at risk of AF development.
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
authors: Mohammadali
authors: M
authors: Habibi
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
authors: Sanaz
authors: S
authors: Samiei
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
authors: Bharath
authors: B
authors: Ambale Venkatesh
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
authors: Anders
authors: A
authors: Opdahl
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
authors: Thomas M
authors: TM
authors: Helle-Valle
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
authors: Mytra
authors: M
authors: Zareian
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
authors: Andre L C
authors: AL
authors: Almeida
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
authors: Eui-Young
authors: EY
authors: Choi
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
authors: Colin
authors: C
authors: Wu
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
authors: Alvaro
authors: A
authors: Alonso
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
authors: Susan R
authors: SR
authors: Heckbert
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.).
authors: David A
authors: DA
authors: Bluemke
authors: From the Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (M.H.); Division of Cardiology, the Johns Hopkins University, School of Medicine, Baltimore, MD (M.H., B.A.V., A.L.C.A., E.-Y.C., J.A.C.L.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.S., M.Z.); Department of Cardiology, Oslo University Hospital, Norway (A.O., T.M.H.-V.); Universidade Estadual de Feira de Santana, Bahia, Brazil (A.L.C.A.); Yonsei University College of Medicine, Seoul, South Korea (E.-Y.C.); Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, MD (C.W.); Department of Epidemiology, Emory University, Atlanta, GA (A.A.); Department of Epidemiology, School of Public Health, University of Washington, Seattle (S.R.H.); and Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (D.A.B.). jlima@jhmi.edu.
authors: João A C
authors: JA
authors: Lima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000208:ethnology* / Q000503:physiopathology; D016279:Atrial Function, Left; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D042241:Early Diagnosis; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: atrial fibrillation; atrial function, left; cardiovascular diseases; heart atria; magnetic resonance imaging