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Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study.
Abstract
BACKGROUND: Although structural heart disease is often present in patients with nonrheumatic atrial fibrillation, the echocardiographic precursors of atrial fibrillation have not been reported previously. In this elderly, population-based cohort, our objective was to examine prospectively the echocardiographic predictors of nonrheumatic atrial fibrillation. METHODS AND RESULTS: Subjects in the Framingham Heart Study were routinely evaluated with M-mode echocardiography; 1924 subjects, ranging in age from 59 to 90 years, comprised the population at risk. Cox proportional hazards modeling was used to analyze the association of selected echocardiographic features with atrial fibrillation risk after adjustment for age, sex, hypertension, coronary heart disease, congestive heart failure, diabetes, and valvular heart disease. During a mean follow-up interval of 7.2 years, 154 subjects (8.0%) developed atrial fibrillation. Multivariable stepwise analysis identified left atrial size (hazard ratio [HR] per 5-mm increment, 1.39; 95% confidence interval [CI], 1.14 to 1.68), left ventricular fractional shortening (HR per 5% decrement, 1.34; 95% CI, 1.08 to 1.66), and sum of septal and left ventricular posterior wall thickness (HR per 4-mm increment, 1.28; 95% CI, 1.03 to 1.60) as independent echocardiographic predictors of atrial fibrillation. For each of the echocardiographic predictors, risk increased progressively over successive quartiles. Moreover, risk increased markedly when highest-risk-quartile measurements for these features were present in combination; the cumulative 8-year age-adjusted atrial fibrillation rates were 7.3% and 17.0%, respectively, when one and two or more highest-risk-quartile features were present, compared with 3.7% when none was present. CONCLUSIONS: In this elderly, population-based sample, left atrial enlargement, increased left ventricular wall thickness, and reduced left ventricular fractional shortening were predictive of risk for nonrheumatic atrial fibrillation. These echocardiographic precursors offer prognostic information beyond that provided by traditional clinical atrial fibrillation risk factors.
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“A number of observational studies have demonstrated the association between female sex and risk of AF-related stroke and thromboembolism (Supplementary Table S6).”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [71]
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“most studies report an increased risk of stroke in women.68–71”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [71]
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Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F. A., Foster, E., Goldstein, S. A., Kuznetsova, T., et al. (2015) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2014.10.003 · Cited by 12,362
Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., Picard, M. H., Roman, M. J., Seward, J., Shanewise, J. S., et al. (2005) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2005.10.005 · Cited by 11,318
Lang, R. M., Badano, L. P., Mor‐Avi, V., Afilalo, J., Armstrong, A. D. C., Ernande, L., Flachskampf, F. A., Foster, E., Goldstein, S. A., Kuznetsova, T., et al. (2015) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jev014 · Cited by 8,630
Impact of Atrial Fibrillation on the Risk of Death: The Framingham Heart Study
Benjamin, E. J., Wolf, P. A., D’Agostino, R. B., Silbershatz, H., Kannel, W. B., & Levy, D. (1998) · Circulation · doi:10.1161/01.cir.98.10.946 · Cited by 4,575
Self-citationRecommendations for chamber quantification☆
Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., Picard, M. H., Roman, M. J., Seward, J. B., & Shanewise, J. S. (2006) · European Journal of Echocardiography · doi:10.1016/j.euje.2005.12.014 · Cited by 3,588
Metadata
- Authors
- Vaziri, S. M., Larson, M. G., Benjamin, E. J., & Levy, D.
- Affiliations
- Framingham Heart Study (US)
- Venue
- Circulation
- Published
- 1994-02
- Volume
- 89
- Issue
- 2
- Pages
- 724-730
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2067232731
- Cited by
- 1,073
- References
- 0
- Citations by year
- 2026: 31 · 2025: 29 · 2024: 41 · 2023: 38 · 2022: 40 · 2021: 54 · 2020: 52 · 2019: 43 · 2018: 51 · 2017: 46 · 2016: 53 · 2015: 52 · 2014: 48 · 2013: 57 · 2012: 50
- FWCI
- 5.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- non-valvular atrial fibrillation, atrial fibrillation risk factors, left atrial enlargement, left ventricular wall thickness, left ventricular fractional shortening, M-mode echocardiography, Framingham Heart Study, structural heart disease
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Echocardiography, Female, Forecasting, Humans, Longitudinal Studies, Male, Middle Aged, Incidence, Proportional Hazards Models
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