title: Electrocardiographic left ventricular hypertrophy predicts atrial fibrillation independent of left ventricular mass.
abstract: BACKGROUND
  Although left ventricular hypertrophy (LVH) detected by electrocardiography (ECG-LVH) and echocardiography (echo-LVH) independently predict cardiovascular disease events, it is unclear if ECG-LVH and echo-LVH independently predict atrial fibrillation (AF).
  
  
  METHODS
  This analysis included 4,904 participants (40% male; 85% white) from the Cardiovascular Health Study who were free of baseline AF and major intraventricular conduction delays. ECG-LVH was defined by Minnesota Code Classification from baseline ECG data. Echo-LVH was defined by sex-specific left ventricular mass values >95th sex-specific percentiles. Incident AF events were identified during the annual study ECGs and from hospitalization discharge data. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association of ECG-LVH and echo-LVH with incident AF, separately.
  
  
  RESULTS
  ECG-LVH was detected in 224 (4.6%) participants and echo-LVH was present in 231 (4.7%) participants. Over a median follow-up of 11.9 years, a total of 1,430 AF events were detected. In a multivariable Cox model adjusted for age, sex, race, education, income, smoking, systolic blood pressure, diabetes, body mass index, total cholesterol, high-density lipoprotein cholesterol, aspirin, antihypertensive medications, and cardiovascular disease, ECG-LVH (HR = 1.50; 95% CI = 1.18, 1.90) and echo-LVH (HR = 1.39; 95% CI = 1.09, 1.78) were independently associated with AF. When ECG-LVH (HR = 1.47, 95% CI = 1.16, 1.87) and echo-LVH (HR = 1.36, 1.07, 1.75) were included in the same model, both were predictive of incident AF.
  
  
  CONCLUSIONS
  The association of ECG-LVH with AF is not dependent on left ventricular mass detected by echocardiography, suggesting that abnormalities in cardiac electrophysiology provide a distinct profile in the prediction of AF.
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Wesley T
authors.initials: WT
authors.lastname: O'Neal
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: S Patrick
authors.initials: SP
authors.lastname: Whalen
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.|Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis*; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D009929:Organ Size; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors
keywords: atrial fibrillation; epidemiology; left ventricle