Background

Global longitudinal strain (GLS) is a sensitive marker of myocardial dysfunction and atrial reservoir function. We sought to evaluate its value for predicting atrial fibrillation (AF) in the general population.

Methods

Participants from the Copenhagen City Heart Study examined with echocardiography, including speckle tracking analyses, were included. The endpoint was AF obtained through national registries. Proportional hazards Cox regression was applied, including multivariable adjustments made for CHADS₂ and CHARGE-AF risk factors. Abnormal GLS was defined as >—18%.

Results

The data from 1,309 participants were analyzed. Of those, 153 (12%) developed AF during a median follow-up time of 15.9 years. The follow-up was 100%. The mean age was 57 years, 38% had hypertension, and GLS was − 18%.

In unadjusted analysis, GLS was a univariable predictor of outcome (1.08 (1.04–1.13), p < 0.001, per 1% absolute decrease), but did not remain an independent predictor after adjusting for neither CHADS₂ nor CHARGE-AF risk factors. However, hypertension modified the relationship between GLS and AF (p for interaction = 0.010), such that GLS only predicted AF in subjects without hypertension. In participants without hypertension, GLS remained an independent predictor of AF after adjusting for CHADS₂ and CHARGE-AF (HR = 1.11 (1.03–1.20) and HR = 1.09 (1.01–1.19), respectively). In these participants, an abnormal GLS was associated with a more than twofold increased risk of AF (HR = 2.16 (1.26–3.72). The incidence rate was 3.17 and 6.81 per 1000 person-years for normal vs. abnormal GLS, respectively.

Conclusion

Global longitudinal strain predicts AF in individuals without hypertension from the general population, independently of common risk scores.

Graphical abstract

中文翻译：

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整体纵向应变预测无高血压个体的心房颤动：一项基于社区的队列研究

背景

全局纵向应变 (GLS) 是心肌功能障碍和心房水库功能的敏感标志物。我们试图评估其在一般人群中预测心房颤动 (AF) 的价值。

方法

来自哥本哈根城市心脏研究的参与者被纳入了超声心动图检查，包括斑点跟踪分析。终点是通过国家注册获得的 AF。应用了比例风险 Cox 回归，包括对 CHADS ₂和 CHARGE-AF 风险因素进行的多变量调整。异常 GLS 定义为 >—18%。

结果

分析了 1,309 名参与者的数据。其中，153 人 (12%) 在中位随访 15.9 年期间发展为 AF。随访率为 100%。平均年龄为 57 岁，38% 患有高血压，GLS 为 − 18%。

在未经调整的分析中，GLS 是结果的单变量预测因子（1.08 (1.04-1.13)，p < 0.001，每绝对减少 1%），但在调整 CHADS ₂和 CHARGE-AF 风险因素后，不再是独立预测因子。然而，高血压改变了 GLS 和 AF 之间的关系（交互作用的 p = 0.010），因此 GLS 只能预测没有高血压的受试者的 AF。在没有高血压的参与者中，在调整 CHADS ₂后，GLS 仍然是 AF 的独立预测因子和 CHARGE-AF（分别为 HR = 1.11 (1.03–1.20) 和 HR = 1.09 (1.01–1.19)）。在这些参与者中，异常 GLS 与 AF 风险增加两倍以上相关（HR = 2.16（1.26-3.72）。正常 GLS 和异常 GLS 的发生率分别为每 1000 人年 3.17 和 6.81。

结论

整体纵向应变预测普通人群中没有高血压的个体的 AF，与常见的风险评分无关。

图形概要