Sex-specific echocardiographic predictors of atrial fibrillation in the general population

Background

In recent years, many echocardiographic parameters have been identified as predictors of atrial fibrillation (AF) in the general population. However, it is currently unknown whether echocardiographic parameters may differentially predict AF in men and women.

Purpose

The aim of this study was to identify potential sex-specific echocardiographic predictors of AF in the general population.

Methods

A total of 4070 individuals (57% women, mean age 56±17 years,) from the general population free of AF, heart failure and prior stroke had an echocardiographic examination performed including tissue Doppler imaging (TDI) and speckle tracking. The primary endpoint was incident AF during follow-up. We investigated the prognostic value of the following echocardiographic parameters: left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), peak atrial longitudinal strain, peak atrial contraction strain, left atrial strain during the conduit phase, left atrial volume index (LAVI), LA emptying fraction, deceleration time, A (peak transmitral late diastolic inflow velocity), E (peak transmitral early diastolic inflow velocity), e’ (average peak early diastolic longitudinal mitral annular velocity determined by color TDI), right ventricular (RV) longitudinal strain (RVLS), tricuspid annular plane systolic excursion, and RV S’.

Our multivariable model was adjusted for age, body mass index, diabetes, hypertension, heart rate, previous ischemic heart disease, systolic blood pressure, diastolic blood pressure, smoking, LVEF, GLS, LAVI, and E/e’.

Results

During a median follow-up of 5 years (interquartile range, 4.4-6.2 years), 82 men (4.7%) and 81 women (3.5%) were diagnosed with incident AF.

Of the investigated echocardiographic parameters, we found that GLS was a univariable predictor of AF in men with 23% increased risk per 1% decrease in GLS (per 1% decrease: HR 1.23; 95% CI (1.14-1.32), p<0.001, Figure 1). After multivariable adjustment for clinical and echocardiographic parameters, the association remained significant in men (per 1% decrease: HR 1.13; 95% CI (1.01-1.27), p=0.038), but not in women.

In women, we found that RVLS was a univariable predictor of AF with 9% increased risk per 1% decrease in RVLS (per 1% decrease: HR 1.09; 95% CI (1.03-1.15), p=0.003, Figure 2). After multivariable adjustment, the association remained significant in women (per 1% decrease: HR 1.12; 95% CI (1.04-1.21), p=0.004), but not in men.

The prognostic value of the other investigated echocardiographic parameters did not differ between men and women with regard to predicting AF.

Conclusion

Echocardiographic predictors of AF in individuals from the general population differ between men and women. Systolic left ventricular function assessed by GLS was an independent predictor of AF in men, while right ventricular function assessed by RVLS was an independent predictor of AF in women.Figure 1Figure 2