Abstract 12716: Left Ventricular Hypertrophy Phenotype to Predict Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

Abstract

Introduction: Left ventricular hypertrophy (LVH) has been shown to be associated with the occurrence of atrial fibrillation (AF). However, due to the heterogeneous nature of LVH, the predictive value of the LVH phenotype for incident AF remains uncertain. Methods: We utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA). In this study, participants who underwent cardiac magnetic resonance imaging examination were included for analysis. LVH was defined as LV mass index ≥ 85.3 g/m 2 for females and ≥ 107.8 g/m 2 for males. Isolated LVH was determined as LVH without elevated cardiac biomarkers, and malignant LVH was determined as LVH with elevated hs-TnT level of ≥14 ng/L, or/and NT Pro-BNP level of ≥125 pg/mL. Results: A total of 4983 participants were included in the final analysis, with a mean age of 61.5 years. 272 (5.6%) had isolated LVH, and 222 (4.5%) had malignant LVH. During a median follow-up of 8.5 years, 272 cases of AF were observed. Compared to participants without LVH or elevated cardiac biomarkers, those with isolated LVH (HR, 1.82; 95% CI, 1.03-3.20) and malignant LVH (HR, 4.13; 95% CI, 2.77-6.16) had higher AF risks after adjusted for age, sex, race, body mass index, systolic blood pressure, antihypertensive medication use, smoking status, and diabetes. Malignant LVH carried a 1.5-fold increased risk (HR: 2.48, 95% CI: 1.30-4.73) of AF compared to isolated LVH (Panel A). Kaplan-Meier cumulative AF incidence curves showed that malignant LVH had a significantly higher incidence of AF than those in other phenotypes (Panel B). Including the LVH phenotype in the CHARGE-AF model improved model discrimination (areas under the curves[AUC] increase: 0.03, p<0.001) (Panel C). Conclusions: The risks of AF incidence varied across LVH phenotypes, showing that malignant LVH carried a higher risk compared to other LVH phenotypes. LVH phenotype could provide additional predictive power for AF occurrence above the CHARGE-AF model.