Differences in Left Atrial Size and Function and Supraventricular Ectopy Between Black and White Participants in the ARIC Study

• Type of Material: Article
• Authors: Wendy Wang, University of Minnesota, Minneapolis; Faye L Norby, Cedars‐Sinai Smidt Heart Institute; Michael J Zhang, University of Minnesota, Minneapolis; Jorge L Reyes, Hennepin County Medical Center; Amil M Shah, Brigham and Women’s Hospital; Elsayed Z Soliman, Wake Forest University; Pamela L Lutsey, Univ Minnesota; Alvaro Alonso, Emory University; Scott D Solomon, Brigham & Womens Hosp; Riccardo M Inciardi, University of Brescia; Lin Y Chen, University of Minnesota Minneapolis
• Language: English
• Date: 2021-11-02
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.121.021723
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 10
• Issue: 21
• Start Page: e021723
• End Page: e021723
• Grant/Funding Information: 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]).; 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.
• Keywords: MEN; TACHYCARDIA; Cardiovascular System & Cardiology; ATHEROSCLEROSIS RISK; COMPLEXES; Life Sciences & Biomedicine; FIBRILLATION; atrial tachycardia; echocardiogram; arrhythmia; race and ethnicity; epidemiology; STROKE; SURVIVAL; ASSOCIATION; DISPARITIES; DESIGN; Cardiac & Cardiovascular Systems; Science & Technology
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

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.