Abstract：
The objective of the study was to examine the joint associations of albuminuria and electrocardiographic left atrial abnormality (ECG-LAA) with incident atrial fibrillation (AF) and whether this relationship varies by race.
This analysis included 6670 participants free of clinical cardiovascular disease (CVD), including atrial fibrillation (AF), from the Multi-Ethnic Study of Atherosclerosis. ECG-LAA was defined as P-wave terminal force in V1 [PTFV1] >5000 μV × ms. Albuminuria was defined as urine albumin-creatinine ratio (UACR) ≥30 mg/g. Incident AF events through 2015 were ascertained from hospital discharge records and study-scheduled electrocardiograms. Cox proportional hazard models were used to examine the association of \"no albuminuria + no ECG-LAA (reference)\", \"isolated albuminuria\", \"isolated ECG-LAA\" and \"albuminuria + ECG-LAA\" with incident AF.
Over a median follow-up of 13.8 years, 979 incident cases of AF occurred. In adjusted models, the concomitant presence of ECG-LAA and albuminuria was associated with a higher risk of AF than either ECG-LAA or albuminuria in isolation (HR (95% CI): 2.43 (1.65-3.58), 1.33 (1.05-1.69), and 1.55 (1.27-1.88), respectively (interaction p-value = 0.50). Effect modification by race was observed with a 4-fold greater AF risk in Black participants with albuminuria + ECG-LAA (HR (95%CI): 4.37 (2.38-8.01) but no significant association in White participants (HR (95% CI) 0.60 (0.19-1.92) respectively; (interaction p-value for race x albuminuria-ECG-LAA combination = 0.05).
Concomitant presence of ECG-LAA and albuminuria confers a higher risk of AF compared to either one in isolation with a stronger association in Blacks than Whites.
This analysis included 6670 participants free of clinical cardiovascular disease (CVD), including atrial fibrillation (AF), from the Multi-Ethnic Study of Atherosclerosis. ECG-LAA was defined as P-wave terminal force in V1 [PTFV1] >5000 μV × ms. Albuminuria was defined as urine albumin-creatinine ratio (UACR) ≥30 mg/g. Incident AF events through 2015 were ascertained from hospital discharge records and study-scheduled electrocardiograms. Cox proportional hazard models were used to examine the association of \"no albuminuria + no ECG-LAA (reference)\", \"isolated albuminuria\", \"isolated ECG-LAA\" and \"albuminuria + ECG-LAA\" with incident AF.
Over a median follow-up of 13.8 years, 979 incident cases of AF occurred. In adjusted models, the concomitant presence of ECG-LAA and albuminuria was associated with a higher risk of AF than either ECG-LAA or albuminuria in isolation (HR (95% CI): 2.43 (1.65-3.58), 1.33 (1.05-1.69), and 1.55 (1.27-1.88), respectively (interaction p-value = 0.50). Effect modification by race was observed with a 4-fold greater AF risk in Black participants with albuminuria + ECG-LAA (HR (95%CI): 4.37 (2.38-8.01) but no significant association in White participants (HR (95% CI) 0.60 (0.19-1.92) respectively; (interaction p-value for race x albuminuria-ECG-LAA combination = 0.05).
Concomitant presence of ECG-LAA and albuminuria confers a higher risk of AF compared to either one in isolation with a stronger association in Blacks than Whites.
摘要：
背景：本研究的目的是研究白蛋白尿和心电图左心房异常（ECG-LAA）与心房颤动（AF）的联合关系，以及这种关系是否因种族而异。
方法：该分析包括6670名没有临床心血管疾病（CVD）的参与者，包括心房颤动(AF),动脉粥样硬化的多民族研究。ECG-LAA定义为V1[PTFV1]>5000μV×ms的P波终末力。白蛋白尿定义为尿白蛋白-肌酐比值（UACR）≥30mg/g。通过出院记录和研究计划的心电图确定2015年的房颤事件。Cox比例风险模型用于检查“无白蛋白尿+无ECG-LAA（参考）”的关联“孤立性蛋白尿”，“孤立的心电图-左心耳”和“白蛋白尿+心电图-左心耳”伴房颤。
结果：中位随访时间为13.8年，发生979例房颤。在调整后的模型中，与单独的ECG-LAA或白蛋白尿相比，同时存在ECG-LAA和白蛋白尿与房颤的风险更高（HR（95％CI）：2.43（1.65-3.58），1.33(1.05-1.69),和1.55（1.27-1.88），分别(相互作用p值=0.50)。在患有白蛋白尿+ECG-LAA的黑人参与者中，观察到按种族进行的效果改变，AF风险增加了4倍（HR（95CI）：4.37（2.38-8.01），但在白人参与者中没有显着相关性（HR（95％CI）分别为0.60（0.19-1.92）；（种族x白蛋白尿-ECG-LAA组合的相互作用p值=0.05）。
结论：同时存在ECG-LAA和白蛋白尿，与单独存在的任何一种相比，都具有更高的房颤风险，黑人的相关性比白人更强。
方法：该分析包括6670名没有临床心血管疾病（CVD）的参与者，包括心房颤动(AF),动脉粥样硬化的多民族研究。ECG-LAA定义为V1[PTFV1]>5000μV×ms的P波终末力。白蛋白尿定义为尿白蛋白-肌酐比值（UACR）≥30mg/g。通过出院记录和研究计划的心电图确定2015年的房颤事件。Cox比例风险模型用于检查“无白蛋白尿+无ECG-LAA（参考）”的关联“孤立性蛋白尿”，“孤立的心电图-左心耳”和“白蛋白尿+心电图-左心耳”伴房颤。
结果：中位随访时间为13.8年，发生979例房颤。在调整后的模型中，与单独的ECG-LAA或白蛋白尿相比，同时存在ECG-LAA和白蛋白尿与房颤的风险更高（HR（95％CI）：2.43（1.65-3.58），1.33(1.05-1.69),和1.55（1.27-1.88），分别(相互作用p值=0.50)。在患有白蛋白尿+ECG-LAA的黑人参与者中，观察到按种族进行的效果改变，AF风险增加了4倍（HR（95CI）：4.37（2.38-8.01），但在白人参与者中没有显着相关性（HR（95％CI）分别为0.60（0.19-1.92）；（种族x白蛋白尿-ECG-LAA组合的相互作用p值=0.05）。
结论：同时存在ECG-LAA和白蛋白尿，与单独存在的任何一种相比，都具有更高的房颤风险，黑人的相关性比白人更强。
