Even Mild Mitral Regurgitation is Associated with Incident Atrial Fibrillation in the General Population
Marat Yafasov, Flemming Javier Olsen, Ali Shabib, Kristoffer Grundtvig Skaarup, Mats Christian Højbjerg Lassen, Niklas Dyrby Johansen, Magnus T Jensen, Gorm Boje Jensen, Peter Schnohr, Rasmus Møgelvang, Tor Biering-Sørensen- Cardiology and Cardiovascular Medicine
- Radiology, Nuclear Medicine and imaging
- General Medicine
Abstract
Background
Mitral regurgitation (MR) can be difficult to quantify. We sought to investigate whether the MR jet area to left atrial (LA) area ratio (MR/LA-ratio) method for quantifying MRs can be used to predict incident AF in the general population.
Methods
The study included 4,466 participants from the 5th Copenhagen City Heart Study, a prospective general population study, who underwent transthoracic echocardiography. MR jet area was measured and indexed to LA area. The endpoint was incident AF.
Results
MR was quantified in 4,042 participants (mean age: 57 years, 43% men). Of these, 198 (4.9%) developed AF during a median follow-up period of 5.3 years (IQR: 4.4-6.1 years). MR was present in 1,938 participants (48%) including 1593 (39%) trace/mild MRs (MR/LA-ratio ≤ 20% and ≤4 cm2). In unadjusted analysis, MR/LA-ratio was associated with incident AF (HR: 1.06 (1.00-1.13), p = 0.042 per 5% increase) but not after adjusting for CHARGE-AF score. However, the association was modified by age (p for interaction = 0.034), such that MR/LA-ratio was associated with AF only in participants ≤73 years. In these participants, MR/LA-ratio was independently associated with AF after adjusting for CHARGE-AF score (HR: 1.14 (1.06-1.24), p = 0.001, per 5% increase). This finding persisted when restricting the analysis to participants without moderate or severe MR and normal LA size (HR: 1.35 (1.09-1.68), p = 0.005, per 5% increase).
Conclusion
Mitral regurgitation, including even trace regurgitations quantified by MR/LA-ratio is independently associated with incident AF in individuals ≤73 years of age.