Markers of Atrial Myopathy in the General Population: Prevalence, Predictors, and Inter-Relations
- PMID: 37676201
- DOI: 10.1016/j.jacep.2023.07.012
Markers of Atrial Myopathy in the General Population: Prevalence, Predictors, and Inter-Relations
Abstract
Background: Atrial myopathy refers to structural and functional cardiac abnormalities associated with atrial fibrillation and stroke, but appropriate diagnostic criteria are lacking.
Objectives: This study aimed to assess prevalence, clinical correlates, and overlap between potential atrial myopathy markers.
Methods: The population-based SCAPIS (Swedish CArdioPulmonary bioImage Study) prospectively included 6,013 subjects without atrial fibrillation with 24-hour electrocardiograms. Resting electrocardiograms measuring P-wave indices were collected at 1 screening site (n = 1,201), and a random sample (n = 385) had echocardiographic left atrial volume index (LAVi). Atrial myopathy markers were defined as ≥500 premature atrial complexes/24 h, LAVi ≥34 mL/m2, P-wave duration >120 milliseconds, or P-wave terminal force in V1 >4,000 ms·s. Clinical correlates included age, sex, body mass index, height, smoking, physical activity, coronary artery disease, diabetes, systolic blood pressure, antihypertensive medication, and low education.
Results: Atrial myopathy was common; 42% of the sample with all diagnostic modalities available had ≥1 atrial myopathy marker, but only 9% had 2 and 0.3% had ≥3. Only P-wave duration and LAVi were correlated (ρ = 0.10; P = 0.04). Clinical correlates of premature atrial complexes, P-wave indices, and LAVi differed; current smoking (34% increase; P < 0.001), systolic blood pressure (4%/mm Hg increase; P = 0.01), diabetes (35% increase; P = 0.001), and coronary artery disease (71% increase; P = 0.003) were associated with premature atrial complexes, physical activity ≥2 h/wk was associated with increased LAVi (β-coefficient = 3.1; P < 0.0001) and body mass index was associated with P-wave duration (β-coefficient = 0.4/kg/m2; P < 0.0001).
Conclusions: In the general population, indirect markers of atrial myopathy are common but only weakly correlated, and their risk factor patterns are different. More studies are needed to accurately identify individuals with atrial myopathy with diagnostic methods.
Keywords: 24hECG; P-wave indices; atrial fibrillation; atrial myopathy; general population; left atrial volume index.
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Funding Support and Author Disclosures Dr Johnson has received support from the Swedish Society of Medicine; and consulting fees from MEDICALgorithmics, outside the scope of the current study. Drs Johnson and Engström have received support from the Swedish Heart and Lung Foundation and the Swedish Research Council. Dr Platonov has received support from the Swedish Heart-Lung Foundation, grants from the Swedish state under the agreement between the Swedish government and the county councils (the ALF agreement), and donation funds from Skåne University Hospital. Dr Conen has received speaker fees from Servier and BMS/Pfizer, as well as advisory board fees from Roche Diagnostics and Trimedics, all outside of the current study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Comment in
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Atrial Cardiomyopathy Manifestations in the General Population: The Tip or the Iceberg?JACC Clin Electrophysiol. 2023 Nov;9(11):2250-2252. doi: 10.1016/j.jacep.2023.09.019. JACC Clin Electrophysiol. 2023. PMID: 38030333 No abstract available.
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