Left ventricular hypertrophy phenotype to predict incident atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis.

Left ventricular hypertrophy (LVH) has been shown to be associated with the occurrence of atrial fibrillation (AF). However, the predictive value of the LVH phenotype for incident AF remains uncertain. This study aimed to investigate the predictive value of LVH phenotype for incident AF. This study utilized the Multi-Ethnic Study of Atherosclerosis (MESA) data. LVH was defined by cardiac magnetic resonance measured LV mass index. Isolated LVH was determined as LVH without elevated cardiac biomarker and malignant LVH was determined as LVH with at least 1 elevated biomarker. Receiver-operating characteristic (ROC) analysis was performed to calculate areas under the curves (AUC) for predicting AF. A total of 4983 community-dwelling participants were included, with a mean age of 61.5 years. 279 (5.6 %) had isolated LVH, and 222 (4.5 %) had malignant LVH. During a median follow-up of 8.5 years, 272 incident AF was observed. Compared to participants without LVH and 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 a higher risk of incident AF. Malignant LVH carried a 1.5-fold increased risk of AF compared to isolated LVH (HR: 2.48, 95 % CI: 1.30–4.73). Including the LVH phenotype in the CHARGE-AF model improved model discrimination (AUC increase: 0.03, p < 0.001). The risks of AF incidence varied across LVH phenotypes. Malignant LVH carried the highest risk among LVH phenotypes. LVH phenotype provides incremental predictive value over the variables included in the CHARGE-AF model. LVH to predict incident AF.Participants who had LVH with elevated cardiac biomarkers carried the highest risk for AF compared to other participants (upper panel and lower left). LVH phenotype improved the discrimination of the CHARGE-AF model (AUC increase: 0.03, p < 0.001; lower right). LVH + indicates the presence of LVH, and LVH– indicates the absence of LVH. Cardiac Biomarker "+" indicates elevated cardiac biomarkers, and "–" indicates normal cardiac biomarkers.Abbreviation. LVH = left ventricular hypertrophy; AF = atrial fibrillation; AUC = areas under curves; CHARGE-AF=Cohorts for Heart and Ageing Research in Genomic Epidemiology model for Atrial Fibrillation. [Display omitted] • LVH exhibits a heterogeneous phenotype, those with elevated biomarkers belong to a more malignant phenotype. • Malignant LVH phenotype carries a higher risk of AF. • LVH phenotype provides additional predictive power for AF occurrence. [ABSTRACT FROM AUTHOR]