1. Interrelations between albuminuria, electrocardiographic left atrial abnormality, and incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.
- Author
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Ahmad, Muhammad Imtiaz, Chen, Lin Y., Singh, Sanjay, Luqman-Arafath, T.K., Kamel, Hooman, and Soliman, Elsayed Z.
- Subjects
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ATRIAL fibrillation , *LEFT heart atrium , *ALBUMINURIA , *PROPORTIONAL hazards models - Abstract
The objective of the study was to examine the joint associations of albuminuria and electrocardiographic left atrial abnormality (ECG-LAA) with incident atrial fibrillation (AF) and whether this relationship varies by race. This analysis included 6670 participants free of clinical cardiovascular disease (CVD), including atrial fibrillation (AF), from the Multi-Ethnic Study of Atherosclerosis. ECG-LAA was defined as P-wave terminal force in V1 [PTFV1] >5000 μV × ms. Albuminuria was defined as urine albumin-creatinine ratio (UACR) ≥30 mg/g. Incident AF events through 2015 were ascertained from hospital discharge records and study-scheduled electrocardiograms. Cox proportional hazard models were used to examine the association of "no albuminuria + no ECG-LAA (reference)", "isolated albuminuria", "isolated ECG-LAA" and "albuminuria + ECG-LAA" with incident AF. Over a median follow-up of 13.8 years, 979 incident cases of AF occurred. In adjusted models, the concomitant presence of ECG-LAA and albuminuria was associated with a higher risk of AF than either ECG-LAA or albuminuria in isolation (HR (95% CI): 2.43 (1.65–3.58), 1.33 (1.05–1.69), and 1.55 (1.27–1.88), respectively (interaction p-value = 0.50). Effect modification by race was observed with a 4-fold greater AF risk in Black participants with albuminuria + ECG-LAA (HR (95%CI): 4.37 (2.38–8.01) but no significant association in White participants (HR (95% CI) 0.60 (0.19–1.92) respectively; (interaction p-value for race x albuminuria-ECG-LAA combination = 0.05). Concomitant presence of ECG-LAA and albuminuria confers a higher risk of AF compared to either one in isolation with a stronger association in Blacks than Whites. • Impact of combination of albuminuria and ECG left atrial abnormality (ECG-LAA) on atrial fibrillation (AF) risk is unknown. • Concomitant presence of albuminuria and ECG-LAA is associated with a greater risk of AF than each predictor in isolation. • Only Black individuals with concomitant albuminuria and ECG-LAA have a higher risk of incident AF. • These findings raise the possibility of a differential mechanistic pathway to AF according to race-ethnicity. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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