Differences in left atrial size and function and supraventricular ectopy between black and white participants in the aric study

Wendy Wang; Faye L. Norby; Michael J. Zhang; Jorge L. Reyes; Amil M. Shah; Elsayed Z. Soliman; Pamela L. Lutsey; Alvaro Alonso; Scott D. Solomon; Riccardo M. Inciardi; Lin Y. Chen

doi:10.1161/JAHA.121.021723

Differences in left atrial size and function and supraventricular ectopy between black and white participants in the aric study

Wendy Wang, Faye L. Norby, Michael J. Zhang, Jorge L. Reyes, Amil M. Shah, Elsayed Z. Soliman, Pamela L. Lutsey, Alvaro Alonso, Scott D. Solomon, Riccardo M. Inciardi, Lin Y. Chen

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

BACKGROUND: Black Americans have more atrial fibrillation risk factors but lower atrial fibrillation risk than White Americans. Left atrial (LA) enlargement and/or dysfunction, frequent atrial tachycardia (AT), and premature atrial contractions (PAC) are associated with increased atrial fibrillation risk. Racial differences in these factors may exist that could explain the difference in atrial fibrillation risk. METHODS AND RESULTS: We included 2133 ARIC (Atherosclerosis Risk in Communities) study participants (aged 74±4.5 years[mean±SD], 59% women, 27% Black participants) who had echocardiograms in 2011 to 2013 and wore the Zio XT Patch (a 2-week continuous heart monitor) in 2016 to 2017. Linear regression was used to analyze (1) differences in AT/day or PAC/hour between Black and White participants, (2) differences in LA measures between Black and White participants, and (3) racial differences in the association of LA measures with AT or PAC frequency. Compared with White participants, Black participants had a higher prevalence of cardiovascular risk factors and disease, lower AT frequency, greater LA size, and lower LA function. After multivariable adjustments, Black participants had 37% (95% CI, 24%– 47%) fewer AT runs/day than White participants. No difference in PAC between races was noted. Greater LA size and reduced LA function are associated with more AT and PAC runs; however, no race interaction was present. CONCLUSIONS: Differences in LA measures are unlikely to explain the difference in atrial fibrillation risk between Black and White individuals. Despite more cardiovascular risk factors and greater atrial remodeling, Black participants have lower AT frequency than White participants. Future research is needed to elucidate the protective mechanisms that confer resilience to atrial ar-rhythmias in Black individuals.

Original language	English (US)
Article number	e021723
Journal	Journal of the American Heart Association
Volume	10
Issue number	21
DOIs	https://doi.org/10.1161/JAHA.121.021723
State	Published - Nov 2 2021

Bibliographical note

Funding Information:
Dr. Shah reports research support from Novartis through Brigham and Women’s Hospital, research support from Philips Ultrasound, personal fees from Philips Ultrasound, and personal fees from Edwards Lifesciences outside the submitted work. Drs. Lutsey, Alonso, and Chen report grants from the National Institutes of Health during the conduct of the study. Dr. Solomon reports grants from Actelion, Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol-Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Lilly, Mesoblast, MyoKardia, National Institutes of Health/National Heart, Lung, and Blood Institute, Neurotronik, Novartis, NovoNordisk, Respicardia, Sanofi Pasteur, and Theracos and personal fees from Abbott, Action, Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Boeringer-Ingelheim, Bristol-Myers Squibb, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, GlaxoSmithKline, Lilly, Merck, Myokardia, Novartis, Roche, Theracos, Quantum Genomics, Cardurion, Janssen, Cardiac Dimensions, Tenaya, Sanofi-Pasteur, Dinaqor, Tremeau, CellProThera, Moderna, American Regent, and Sarepta outside the submitted work. Dr Inciardi reports speaker and advisor honoraria from Daiichi-Sankyo and Boehringer Ingelheim. The remaining authors have no disclosures to report.

Funding Information:
The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services under contracts HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. This work was also supported by grants from the National Institute of General Medical Sciences (T32GM132063 [WW]) and the National Heart Lung and Blood Institute (R01HL126637 [LYC], R01HL141288 [LYC], K24HL155813 [LYC], K24HL148521 [AA], K24HL159246 [PLL], R01HL135008 [AMS], R01HL143224 [AMS], R01HL150342 [AMS], R01HL148218 [AMS], K24HL152008 [AMS]).

Publisher Copyright:
© 2021 The Authors.

Keywords

Arrhythmia
Atrial tachycardia
Echocardiogram
Epidemiology
Race and ethnicity

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10.1161/JAHA.121.021723

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Wang, W., Norby, F. L., Zhang, M. J., Reyes, J. L., Shah, A. M., Soliman, E. Z., Lutsey, P. L., Alonso, A., Solomon, S. D., Inciardi, R. M., & Chen, L. Y. (2021). Differences in left atrial size and function and supraventricular ectopy between black and white participants in the aric study. Journal of the American Heart Association, 10(21), Article e021723. https://doi.org/10.1161/JAHA.121.021723

Wang, W, Norby, FL , Zhang, MJ , Reyes, JL, Shah, AM, Soliman, EZ, Lutsey, PL, Alonso, A, Solomon, SD, Inciardi, RM & Chen, LY 2021, 'Differences in left atrial size and function and supraventricular ectopy between black and white participants in the aric study', Journal of the American Heart Association, vol. 10, no. 21, e021723. https://doi.org/10.1161/JAHA.121.021723

@article{99ae469ec3c5495e9a11c5f3b059c592,

title = "Differences in left atrial size and function and supraventricular ectopy between black and white participants in the aric study",

abstract = "BACKGROUND: Black Americans have more atrial fibrillation risk factors but lower atrial fibrillation risk than White Americans. Left atrial (LA) enlargement and/or dysfunction, frequent atrial tachycardia (AT), and premature atrial contractions (PAC) are associated with increased atrial fibrillation risk. Racial differences in these factors may exist that could explain the difference in atrial fibrillation risk. METHODS AND RESULTS: We included 2133 ARIC (Atherosclerosis Risk in Communities) study participants (aged 74±4.5 years[mean±SD], 59\% women, 27\% Black participants) who had echocardiograms in 2011 to 2013 and wore the Zio XT Patch (a 2-week continuous heart monitor) in 2016 to 2017. Linear regression was used to analyze (1) differences in AT/day or PAC/hour between Black and White participants, (2) differences in LA measures between Black and White participants, and (3) racial differences in the association of LA measures with AT or PAC frequency. Compared with White participants, Black participants had a higher prevalence of cardiovascular risk factors and disease, lower AT frequency, greater LA size, and lower LA function. After multivariable adjustments, Black participants had 37\% (95\% CI, 24\%– 47\%) fewer AT runs/day than White participants. No difference in PAC between races was noted. Greater LA size and reduced LA function are associated with more AT and PAC runs; however, no race interaction was present. CONCLUSIONS: Differences in LA measures are unlikely to explain the difference in atrial fibrillation risk between Black and White individuals. Despite more cardiovascular risk factors and greater atrial remodeling, Black participants have lower AT frequency than White participants. Future research is needed to elucidate the protective mechanisms that confer resilience to atrial ar-rhythmias in Black individuals.",

keywords = "Arrhythmia, Atrial tachycardia, Echocardiogram, Epidemiology, Race and ethnicity",

author = "Wendy Wang and Norby, \{Faye L.\} and Zhang, \{Michael J.\} and Reyes, \{Jorge L.\} and Shah, \{Amil M.\} and Soliman, \{Elsayed Z.\} and Lutsey, \{Pamela L.\} and Alvaro Alonso and Solomon, \{Scott D.\} and Inciardi, \{Riccardo M.\} and Chen, \{Lin Y.\}",

note = "Funding Information: Dr. Shah reports research support from Novartis through Brigham and Women{\textquoteright}s Hospital, research support from Philips Ultrasound, personal fees from Philips Ultrasound, and personal fees from Edwards Lifesciences outside the submitted work. Drs. Lutsey, Alonso, and Chen report grants from the National Institutes of Health during the conduct of the study. Dr. Solomon reports grants from Actelion, Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol-Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Lilly, Mesoblast, MyoKardia, National Institutes of Health/National Heart, Lung, and Blood Institute, Neurotronik, Novartis, NovoNordisk, Respicardia, Sanofi Pasteur, and Theracos and personal fees from Abbott, Action, Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Boeringer-Ingelheim, Bristol-Myers Squibb, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, GlaxoSmithKline, Lilly, Merck, Myokardia, Novartis, Roche, Theracos, Quantum Genomics, Cardurion, Janssen, Cardiac Dimensions, Tenaya, Sanofi-Pasteur, Dinaqor, Tremeau, CellProThera, Moderna, American Regent, and Sarepta outside the submitted work. Dr Inciardi reports speaker and advisor honoraria from Daiichi-Sankyo and Boehringer Ingelheim. The remaining authors have no disclosures to report. Funding Information: The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services under contracts HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. This work was also supported by grants from the National Institute of General Medical Sciences (T32GM132063 [WW]) and the National Heart Lung and Blood Institute (R01HL126637 [LYC], R01HL141288 [LYC], K24HL155813 [LYC], K24HL148521 [AA], K24HL159246 [PLL], R01HL135008 [AMS], R01HL143224 [AMS], R01HL150342 [AMS], R01HL148218 [AMS], K24HL152008 [AMS]). Publisher Copyright: {\textcopyright} 2021 The Authors.",

year = "2021",

month = nov,

day = "2",

doi = "10.1161/JAHA.121.021723",

language = "English (US)",

volume = "10",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "American Heart Association Inc.",

number = "21",

}

TY - JOUR

T1 - Differences in left atrial size and function and supraventricular ectopy between black and white participants in the aric study

AU - Wang, Wendy

AU - Norby, Faye L.

AU - Zhang, Michael J.

AU - Reyes, Jorge L.

AU - Shah, Amil M.

AU - Soliman, Elsayed Z.

AU - Lutsey, Pamela L.

AU - Alonso, Alvaro

AU - Solomon, Scott D.

AU - Inciardi, Riccardo M.

AU - Chen, Lin Y.

N1 - Funding Information: Dr. Shah reports research support from Novartis through Brigham and Women’s Hospital, research support from Philips Ultrasound, personal fees from Philips Ultrasound, and personal fees from Edwards Lifesciences outside the submitted work. Drs. Lutsey, Alonso, and Chen report grants from the National Institutes of Health during the conduct of the study. Dr. Solomon reports grants from Actelion, Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol-Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Lilly, Mesoblast, MyoKardia, National Institutes of Health/National Heart, Lung, and Blood Institute, Neurotronik, Novartis, NovoNordisk, Respicardia, Sanofi Pasteur, and Theracos and personal fees from Abbott, Action, Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Boeringer-Ingelheim, Bristol-Myers Squibb, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi-Sankyo, GlaxoSmithKline, Lilly, Merck, Myokardia, Novartis, Roche, Theracos, Quantum Genomics, Cardurion, Janssen, Cardiac Dimensions, Tenaya, Sanofi-Pasteur, Dinaqor, Tremeau, CellProThera, Moderna, American Regent, and Sarepta outside the submitted work. Dr Inciardi reports speaker and advisor honoraria from Daiichi-Sankyo and Boehringer Ingelheim. The remaining authors have no disclosures to report. Funding Information: The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services under contracts HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. This work was also supported by grants from the National Institute of General Medical Sciences (T32GM132063 [WW]) and the National Heart Lung and Blood Institute (R01HL126637 [LYC], R01HL141288 [LYC], K24HL155813 [LYC], K24HL148521 [AA], K24HL159246 [PLL], R01HL135008 [AMS], R01HL143224 [AMS], R01HL150342 [AMS], R01HL148218 [AMS], K24HL152008 [AMS]). Publisher Copyright: © 2021 The Authors.

PY - 2021/11/2

Y1 - 2021/11/2

N2 - BACKGROUND: Black Americans have more atrial fibrillation risk factors but lower atrial fibrillation risk than White Americans. Left atrial (LA) enlargement and/or dysfunction, frequent atrial tachycardia (AT), and premature atrial contractions (PAC) are associated with increased atrial fibrillation risk. Racial differences in these factors may exist that could explain the difference in atrial fibrillation risk. METHODS AND RESULTS: We included 2133 ARIC (Atherosclerosis Risk in Communities) study participants (aged 74±4.5 years[mean±SD], 59% women, 27% Black participants) who had echocardiograms in 2011 to 2013 and wore the Zio XT Patch (a 2-week continuous heart monitor) in 2016 to 2017. Linear regression was used to analyze (1) differences in AT/day or PAC/hour between Black and White participants, (2) differences in LA measures between Black and White participants, and (3) racial differences in the association of LA measures with AT or PAC frequency. Compared with White participants, Black participants had a higher prevalence of cardiovascular risk factors and disease, lower AT frequency, greater LA size, and lower LA function. After multivariable adjustments, Black participants had 37% (95% CI, 24%– 47%) fewer AT runs/day than White participants. No difference in PAC between races was noted. Greater LA size and reduced LA function are associated with more AT and PAC runs; however, no race interaction was present. CONCLUSIONS: Differences in LA measures are unlikely to explain the difference in atrial fibrillation risk between Black and White individuals. Despite more cardiovascular risk factors and greater atrial remodeling, Black participants have lower AT frequency than White participants. Future research is needed to elucidate the protective mechanisms that confer resilience to atrial ar-rhythmias in Black individuals.

AB - BACKGROUND: Black Americans have more atrial fibrillation risk factors but lower atrial fibrillation risk than White Americans. Left atrial (LA) enlargement and/or dysfunction, frequent atrial tachycardia (AT), and premature atrial contractions (PAC) are associated with increased atrial fibrillation risk. Racial differences in these factors may exist that could explain the difference in atrial fibrillation risk. METHODS AND RESULTS: We included 2133 ARIC (Atherosclerosis Risk in Communities) study participants (aged 74±4.5 years[mean±SD], 59% women, 27% Black participants) who had echocardiograms in 2011 to 2013 and wore the Zio XT Patch (a 2-week continuous heart monitor) in 2016 to 2017. Linear regression was used to analyze (1) differences in AT/day or PAC/hour between Black and White participants, (2) differences in LA measures between Black and White participants, and (3) racial differences in the association of LA measures with AT or PAC frequency. Compared with White participants, Black participants had a higher prevalence of cardiovascular risk factors and disease, lower AT frequency, greater LA size, and lower LA function. After multivariable adjustments, Black participants had 37% (95% CI, 24%– 47%) fewer AT runs/day than White participants. No difference in PAC between races was noted. Greater LA size and reduced LA function are associated with more AT and PAC runs; however, no race interaction was present. CONCLUSIONS: Differences in LA measures are unlikely to explain the difference in atrial fibrillation risk between Black and White individuals. Despite more cardiovascular risk factors and greater atrial remodeling, Black participants have lower AT frequency than White participants. Future research is needed to elucidate the protective mechanisms that confer resilience to atrial ar-rhythmias in Black individuals.

KW - Arrhythmia

KW - Atrial tachycardia

KW - Echocardiogram

KW - Epidemiology

KW - Race and ethnicity

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U2 - 10.1161/JAHA.121.021723

DO - 10.1161/JAHA.121.021723

M3 - Article

C2 - 34713724

AN - SCOPUS:85120820451

SN - 2047-9980

VL - 10

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 21

M1 - e021723

ER -

Differences in left atrial size and function and supraventricular ectopy between black and white participants in the aric study

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