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Global longitudinal strain predicts atrial fibrillation in individuals without hypertension: A Community-based cohort study

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Abstract

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.

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Availability of data and material

The data are not publicly available. We cannot share the data source according to Danish legislation, but data output can be obtained upon reasonable request.

References

  1. Staerk L, Wang B, Preis SR et al (2018) Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham Heart Study. BMJ 361:k1453. https://doi.org/10.1136/bmj.k1453

    Article  PubMed  PubMed Central  Google Scholar 

  2. Magnussen C, Niiranen TJ, Ojeda FM et al (2017) Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: results from the biomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation 136:1588–1597. https://doi.org/10.1161/CIRCULATIONAHA.117.028981

    Article  PubMed  PubMed Central  Google Scholar 

  3. Benjamin EJ, Muntner P, Alonso A et al (2019) Heart disease and stroke statistics-2019 update: a report from the american heart association. Circulation 139:e56–e528. https://doi.org/10.1161/CIR.0000000000000659

    Article  PubMed  Google Scholar 

  4. Seko Y, Kato T, Haruna T et al (2018) Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling. Sci Rep 8:6366. https://doi.org/10.1038/s41598-018-24875-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Bloch Thomsen PE, Jons C, Raatikainen MJP et al (2010) Long-term recording of cardiac arrhythmias with an implantable cardiac monitor in patients with reduced ejection fraction after acute myocardial infarction: the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) study. Circulation 122:1258–1264. https://doi.org/10.1161/CIRCULATIONAHA.109.902148

    Article  PubMed  Google Scholar 

  6. Ersbøll M, Valeur N, Mogensen UM et al (2013) Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction. J Am Coll Cardiol 61:2365–2373. https://doi.org/10.1016/j.jacc.2013.02.061

    Article  PubMed  Google Scholar 

  7. Smiseth OA, Torp H, Opdahl A et al (2016) Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J 37:1196–1207. https://doi.org/10.1093/eurheartj/ehv529

    Article  PubMed  Google Scholar 

  8. Nagueh SF, Smiseth OA, Appleton CP et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the american society of echocardiography and the european association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging 17:1321–1360. https://doi.org/10.1093/ehjci/jew082

    Article  PubMed  Google Scholar 

  9. Olsen FJ, Pedersen S, Jensen JS, Biering-Sørensen T (2016) Global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction. Medicine (Baltimore) 95:e5338. https://doi.org/10.1097/MD.0000000000005338

    Article  Google Scholar 

  10. Bruun Pedersen K, Madsen C, Sandgaard NCF et al (2019) Left atrial volume index and left ventricular global longitudinal strain predict new-onset atrial fibrillation in patients with transient ischemic attack. Int J Cardiovasc Imaging 35:1277–1286. https://doi.org/10.1007/s10554-019-01586-w

    Article  PubMed  Google Scholar 

  11. Appleyard M, Copenhagen City Heart Study Group (1989) The Copenhagen city heart study. osterbroundersøgelsen. a book of tables with data from the first examination (1976–78) and a five year follow-up (1981–83). the copenhagen city heart study group. Scand J Soc Med Suppl 41:1–160

    Google Scholar 

  12. Schnohr P, Parner G, Lange P, Schaling H, Appleyard M (2001) The Copenhagen City Heart Study. Eur Hear J Suppl 3:H1–H83

    Article  Google Scholar 

  13. Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16:233–270. https://doi.org/10.1093/ehjci/jev014

    Article  PubMed  Google Scholar 

  14. Johansen ND, Biering-Sørensen T, Jensen JS, Mogelvang R (2017) Diastolic dysfunction revisited: A new, feasible, and unambiguous echocardiographic classification predicts major cardiovascular events. Am Heart J 188:136–146. https://doi.org/10.1016/j.ahj.2017.03.013

    Article  PubMed  Google Scholar 

  15. Biering-Sørensen T, Biering-Sørensen SR, Olsen FJ et al (2017) Global Longitudinal strain by echocardiography predicts long-term risk of cardiovascular morbidity and mortality in a low-risk general population: the copenhagen city heart study. Circ Cardiovasc Imaging. https://doi.org/10.1161/CIRCIMAGING.116.005521

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kocabay G, Muraru D, Peluso D et al (2014) Normal left ventricular mechanics by two-dimensional speckle-tracking echocardiography. Reference values in healthy adults. Rev Espanola Cardiol Engl Ed 67:651–658. https://doi.org/10.1016/j.rec.2013.12.009

    Article  Google Scholar 

  17. Sundbøll J, Adelborg K, Munch T et al (2016) Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study. BMJ Open 6:e012832. https://doi.org/10.1136/bmjopen-2016-012832

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mukamal KJ, Tolstrup JS, Friberg J et al (2005) Alcohol consumption and risk of atrial fibrillation in men and women: the Copenhagen City Heart Study. Circulation 112:1736–1742. https://doi.org/10.1161/CIRCULATIONAHA.105.547844

    Article  PubMed  Google Scholar 

  19. Gage BF, Waterman AD, Shannon W et al (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285:2864–2870. https://doi.org/10.1001/jama.285.22.2864

    Article  CAS  PubMed  Google Scholar 

  20. Alonso A, Krijthe BP, Aspelund T et al (2013) Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGE-AF consortium. J Am Heart Assoc 2:e000102. https://doi.org/10.1161/JAHA.112.000102

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gaborit F, Bosselmann H, Tønder N et al (2015) Association between left ventricular global longitudinal strain and natriuretic peptides in outpatients with chronic systolic heart failure. BMC Cardiovasc Disord 15:92. https://doi.org/10.1186/s12872-015-0063-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Solomon SD, Biering-Sørensen T (2017) LA strain when ejection fraction is preserved: a new measure of diastolic function? JACC Cardiovasc Imaging 10:744–746. https://doi.org/10.1016/j.jcmg.2016.09.018

    Article  PubMed  Google Scholar 

  23. Ersbøll M, Andersen MJ, Valeur N et al (2013) The prognostic value of left atrial peak reservoir strain in acute myocardial infarction is dependent on left ventricular longitudinal function and left atrial size. Circ Cardiovasc Imaging 6:26–33. https://doi.org/10.1161/CIRCIMAGING.112.978296

    Article  PubMed  Google Scholar 

  24. Alhakak AS, Biering-Sørensen SR, Møgelvang R et al (2020) Usefulness of left atrial strain for predicting incident atrial fibrillation and ischaemic stroke in the general population. Eur Heart J Cardiovasc Imaging. https://doi.org/10.1093/ehjci/jeaa287

    Article  PubMed  Google Scholar 

  25. Russo C, Jin Z, Sera F et al (2015) Left ventricular systolic dysfunction by longitudinal strain is an independent predictor of incident atrial fibrillation: a community-based cohort study. Circ Cardiovasc Imaging 8:e003520. https://doi.org/10.1161/CIRCIMAGING.115.003520

    Article  PubMed  PubMed Central  Google Scholar 

  26. Modin D, Biering-Sørensen SR, Mogelvang R et al (2018) Prognostic value of echocardiography in hypertensive versus nonhypertensive participants from the general population. Hypertension 71:742–751. https://doi.org/10.1161/HYPERTENSIONAHA.117.10674

    Article  CAS  PubMed  Google Scholar 

  27. Loncaric F, Bijnens B, Sitges M (2018) Added value of cardiac deformation imaging in differential diagnosis of left ventricular hypertrophy. Glob Cardiol Sci Pract. https://doi.org/10.21542/gcsp.2018.21

  28. Frimodt-Moeller KE, Olsen FJ, Biering-Sørensen SR, et al (2019) Regional strain patterns according to hypertension and left ventricular hypertrophy in the general population. Eur Heart J ehz745.0037 (abstract)

  29. Russell K, Eriksen M, Aaberge L et al (2012) A novel clinical method for quantification of regional left ventricular pressure-strain loop area: a non-invasive index of myocardial work. Eur Heart J 33:724–733. https://doi.org/10.1093/eurheartj/ehs016

    Article  PubMed  PubMed Central  Google Scholar 

  30. Olsen FJ, Møgelvang R, Jensen GB et al (2019) Relationship between left atrial functional measures and incident atrial fibrillation in the general population: the copenhagen city heart study. JACC Cardiovasc Imaging 12:981–989. https://doi.org/10.1016/j.jcmg.2017.12.016

    Article  PubMed  Google Scholar 

  31. Vittinghoff E, McCulloch CE (2007) Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 165:710–718. https://doi.org/10.1093/aje/kwk052

    Article  PubMed  Google Scholar 

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Funding

Flemming Javier Olsen was funded by the Danish Heart Foundation (Grant no.: 18-R125-A8534-22083), Kong Christian den Tiendes Fond, Fru Asta Florida Boldings Mindelegat, and Herlev & Gentofte Hospitals Research Fund. TBS was supported by the Fondbørsvekselerer Henry Hansen og Hustrus Hovedlegat. The Danish Heart Foundation also funded the Copenhagen City Heart Study, and the echocardiographic substudy was funded by the Lundbeck Foundation.

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Authors and Affiliations

  1. The Copenhagen City Heart Study, Frederiksberg, Denmark

    Flemming Javier Olsen, Sofie Reumert Biering-Sørensen, Anne Marie Reimer Jensen, Peter Schnohr, Gorm Boje Jensen, Rasmus Møgelvang & Tor Biering-Sørensen

  2. Department of Cardiology, Cardiovascular Non-Invasive Imaging Research Laboratory, Herlev & Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark

    Flemming Javier Olsen, Anne Marie Reimer Jensen & Tor Biering-Sørensen

  3. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Jesper Hastrup Svendsen & Rasmus Møgelvang

  4. Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Jesper Hastrup Svendsen & Rasmus Møgelvang

  5. Department of Clinical Research, Faculty of Health and Medical Sciences, University of Southern Denmark, Svendborg, Denmark

    Rasmus Møgelvang

  6. Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Tor Biering-Sørensen

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  1. Flemming Javier Olsen
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Correspondence to Flemming Javier Olsen.

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Olsen, F.J., Biering-Sørensen, S.R., Reimer Jensen, A.M. et al. Global longitudinal strain predicts atrial fibrillation in individuals without hypertension: A Community-based cohort study. Clin Res Cardiol 110, 1801–1810 (2021). https://doi.org/10.1007/s00392-021-01921-z

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  • DOI: https://doi.org/10.1007/s00392-021-01921-z

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