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

TY - JOUR

T1 - Left atrial size and function as predictors of new-onset of atrial fibrillation in patients with asymptomatic aortic stenosis

T2 - The simvastatin and ezetimibe in aortic stenosis study

AU - Bang, Casper N

AU - Dalsgaard, Morten

AU - Greve, Anders M

AU - Køber, Lars

AU - Gohlke-Baerwolf, Christa

AU - Ray, Simon

AU - Rossebø, Anne B

AU - Egstrup, Kenneth

AU - Wachtell, Kristian

N1 - Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

PY - 2013/10/3

Y1 - 2013/10/3

N2 - 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 ≤ 4.0 m/s), preserved LV ejection fraction (EF), no previous AF, and were enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study. Peak-aortic velocity, LAmax volume & LAmin volume were measured by echocardiography. LA conduit (LAcon) volume was defined as LV stroke volume - LA stroke volume. LA function was expressed as LA-EF (LAmax - LAmin volume/LAmax). 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 cm2/m2, LV mass 99.2 ± 29.7 g/m2, LAmax volume 34.6 ± 12.0 mL/m2, LAmin volume 17.9 ± 9.3 mL/m2, LA-EF 50 ± 15% and LAcon 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). Conclusion LAmin volume independently predicted new-onset AF in patients with asymptomatic AS and was superior to LA-EF, LAcon and LAmax volumes and conventional risk factors.

AB - 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 ≤ 4.0 m/s), preserved LV ejection fraction (EF), no previous AF, and were enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study. Peak-aortic velocity, LAmax volume & LAmin volume were measured by echocardiography. LA conduit (LAcon) volume was defined as LV stroke volume - LA stroke volume. LA function was expressed as LA-EF (LAmax - LAmin volume/LAmax). 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 cm2/m2, LV mass 99.2 ± 29.7 g/m2, LAmax volume 34.6 ± 12.0 mL/m2, LAmin volume 17.9 ± 9.3 mL/m2, LA-EF 50 ± 15% and LAcon 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). Conclusion LAmin volume independently predicted new-onset AF in patients with asymptomatic AS and was superior to LA-EF, LAcon and LAmax volumes and conventional risk factors.

U2 - 10.1016/j.ijcard.2013.01.060

DO - 10.1016/j.ijcard.2013.01.060

M3 - Journal article

C2 - 23416018

SN - 0167-5273

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -