Vidhushei Yogeswaran

Abnormal cardiac atrial structure and function, termed atrial cardiopathy, typically precedes atrial fibrillation and downstream cardiovascular complications, yet detection is limited by the cost and accessibility of high-quality cardiac imaging. Here we show that a deep learning model trained on 12-lead electrocardiograms paired with 21,749 cardiac magnetic resonance scans from the UK Biobank predicts left atrial structure and function. Model-derived measures of atrial cardiopathy are strongly associated with new-onset atrial fibrillation, heart failure, and ischemic stroke after adjustment for clinical risk factors and biomarkers in two external cohorts, with magnitudes comparable to or greater than those for direct imaging measures and clinical risk factors. The risk of cardioembolic stroke, the hallmark complication of atrial fibrillation, increases 66% per standard deviation of left atrial volume. In exploratory analyses, model measures predict cardiac monitor-detected atrial fibrillation more accurately than a clinical risk prediction tool and NT-proBNP levels. This model is an inexpensive, accessible tool that identifies individuals at high-risk for atrial fibrillation and related complications.

BACKGROUND: Atrial cardiopathy often precedes atrial fibrillation (AF) and has emerged as an independent risk factor for cardiovascular outcomes. However, previous studies have been limited in size and have overlooked the right atrium. METHODS: In 51 693 UK Biobank participants without prevalent AF, we assessed biatrial volumes and emptying fraction from cardiac magnetic resonance imaging using deep learning segmentation. We evaluated associations with new-onset AF, ischemic stroke, heart failure, and dementia, conducted a genome-wide association study, and evaluated causal associations using Mendelian randomization. RESULTS: Among 51 693 adults, the mean (SD) age was 65 (7.7) years, and 24 584 (48%) were male. During the 4-year follow-up, 964 (1.9%) developed AF, 266 (0.5%) developed ischemic stroke, 365 (0.7%) developed heart failure, and 72 (0.1%) developed dementia. After adjustment for clinical risk factors, both left and right atrial measures were associated with new-onset AF (left atrial minimal volume; hazard ratio, 1.55 [95% CI, 1.48–1.62]), ischemic stroke, and heart failure, with stronger associations in women. Left atrial minimal volume was also associated with dementia. Our genome-wide association study identified 51 (27 novel) genetic associations with atrial measures, many of which do not overlap with established AF loci. Genetic correlations revealed that each atrium had varying correlations with cardiometabolic risk factors, and Mendelian randomization demonstrated that left atrial measures had direct causal effects on AF and stroke risk. However, the stroke associations were attenuated after accounting for AF variants. CONCLUSIONS: In this largest assessment of biatrial structure and function to date, both left and right atrial cardiopathies were independently associated with increased risk of adverse cardiovascular events. We identified several novel genetic loci for atrial traits and observed unique genetic correlations between left and right atrial traits and cardiovascular phenotypes, providing insight into chamber-specific remodeling. Several of these measures are likely to be causal determinants of cardiovascular complications previously attributed to AF.

Background: Atrial cardiomyopathy, defined as adverse changes to the cardiac atria, is an emerging risk factor for atrial fibrillation (AF). Despite the disproportionate burden of AF‐related complications in Black adults, the relationship between electrocardiographic (ECG) measures of atrial cardiomyopathy, referred to as P‐wave indices (PWIs), and outcomes remains largely unknown in this population. Methods: In 4900 participants without AF at baseline from the JHS (Jackson Heart Study), a prospective cohort study of Black adults, we assessed atrial cardiomyopathy using PWIs from resting 12‐lead ECGs: PR interval, P‐wave duration, P‐wave axis, and P‐wave terminal force in V1 (PTFV1). Cox proportional hazards models evaluated associations of PWIs with incident AF and ischemic stroke, adjusting for established risk factors. Results: Over 13.7 years of follow‐up, 396 (9.3%) participants developed incident AF, and 135 (3.8%) experienced ischemic stroke. Each SD‐unit increase in PR interval, P‐wave duration, and PTFV1 was associated with increased AF risk, with the strongest association for PTFV1 (hazard ratio [HR], 1.27 [95% CI, 1.16–1.38]). These PWIs were also associated with AF risk using clinically accepted thresholds, including HR of 1.76 for PTFV1 ≥4000 ms×μV (95%CI, 1.38–2.25). Each SD increase in PTFV1 was associated with a 22% increased risk of ischemic stroke (HR, 1.22 [95% CI, 1.07–1.40]). Conclusions: In this large cohort study of Black adults, PWIs, particularly PTFV1, were independently associated with an increased risk of incident AF and ischemic stroke. These findings underscore the significance of PTFV1 as an underlying marker of atrial cardiomyopathy in Black adults.

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, can lead to heart failure, stroke, dementia, and death.¹ Large population-based studies have reported that the incidence of clinically recognized AF is lower in Black adults than in White adults^2,3; however, cross-sectional studies using unbiased methods of arrhythmia detection suggest that the prevalence rates are similar.⁴ Paradoxically, Black adults with AF have higher rates of ischemic stroke and AF-related complications compared with White adults.^5,6 Given these disparities, there is a need to improve AF screening and detection for Black adults.

Background Social determinants of health (SDOH) may be related to CV risk in women with and without breast cancer (BC). Methods In 153,401 women without prevalent CV disease in the Women’s Health Initiative (WHI), SDOH factors included geographic region, rurality, insurance status, and household income. Cox proportional hazard models were used to assess associations between SDOH factors and a composite CV outcome (myocardial infarction, stroke, hospitalization for heart failure, or CV death). Effect modification by BC was assessed between BC status and SDOH. Results The final cohort included 10,954 (mean age 62±7 years) women who subsequently developed BC and 142,144 (mean age 63 ± 7) women without BC. During a median follow-up of 13 years, 18,148 women had an incident composite CV outcome. Rurality, low household income, and non-private insurance were associated with an increased risk of composite CV outcome and mortality in both women with and without BC. There was no effect modification by BC status for associations with rurality, insurance, or household income. By geographic region, there was no difference in composite CV outcome in women without BC. However, there was a significant interaction by BC status for geographic region and the composite endpoint (p=0.009). Women with BC in the South had a lower risk of the composite outcome (HR 0.68, 95% CI 0.54-0.87). Conclusions SDOH are associated with an increased risk of CV events and mortality among women. There were no differential associations based on BC status, suggesting that women with BC face similar vulnerabilities related to SDOH.

Objectives Patients with congenital heart disease (CHD) are increasingly pursuing pregnancy, highlighting the need for data on late cardiovascular events (more than 6 months after delivery). We aimed to determine the incidence of late cardiovascular events in postpartum patients with CHD and evaluate the accuracy of the existing risk scores in predicting these events. Study design We identified patients with CHD who delivered between 2008 and 2020 at a tertiary centre and had follow-up data for greater than 6 months post partum. Late cardiovascular events were defined as heart failure, arrhythmia, thromboembolic events, endocarditis, urgent cardiovascular interventions or death. Survival analysis and Cox proportional model were used to estimate the incidence of late cardiovascular events and determine the hazard ratio of factors associated with these events. Results Of 117 patients, 19% had 36 late cardiovascular events over a median follow-up of 3.8 years. Annual incidence of any late cardiovascular event was 5.7%. Hazards of late cardiovascular events were significantly higher among those with higher Cardiac Disease in Pregnancy Study (CARPREG) II and Zwangerschap bij Aangeboren HARtAfwijking-Pregnancy in Women With Congenital Heart Disease (ZAHARA) risk scores and among patients with prepregnancy New York Heart Association class≥II. C-statistic to predict the late cardiovascular events was highest for ZAHARA (0.7823), followed by CARPREG II (0.6902) and prepregnancy New York Heart Association class≥ II (0.6677). Conclusions Currently available risk tools designed for prognostication during the peripartum period can also be used to determine risks of late maternal cardiovascular events among those with CHD. These findings provide important new information for counselling and risk modification.

Since the nationally televised cardiac arrest of American National Football League player Damar Hamlin in January 2023, commotio cordis has come to the forefront of public attention. Commotio cordis is defined as sudden cardiac arrest due to direct trauma to the precordium resulting in ventricular fibrillation or ventricular tachycardia. While the precise incidence of commotio cordis is not known due to a lack of standardized, mandated reporting, it is the third most common cause of sudden cardiac death in young athletes, with more than 75% of cases occurring during organized and recreational sporting events. Given that survival is closely tied to how quickly victims receive cardiopulmonary resuscitation and defibrillation, it is crucial to raise awareness of commotio cordis so that athletic trainers, coaches, team physicians, and emergency medical personnel can rapidly diagnose and treat this often-fatal condition. Broader distribution of automated external defibrillators in sporting facilities as well as increased presence of medical personnel during sporting events would also likely lead to higher survival rates.