Subclinical Atrial Fibrillation and Supraventricular Ectopy in the Jackson Heart Study

摘要 房颤(房颤)是一种常见的心律失常，可造成毁灭性的后果，包括 中风和认知功能加速衰退。因为房颤通常是无症状的，可以逃避临床 检测(亚临床房颤)，传统的房颤识别方法低估了人群 房颤的负担。与白人相比，非洲裔美国人患房颤的风险较低，但他们遭受的风险更大 中风和认知障碍。亚临床房颤和另一种重要心律失常的高患病率， 室上性异位(SVE)可能有助于解释这一悖论。此外，几个新出现的风险因素 对于房颤和SVE，包括血压的长期变化，低钾血症，某些药物的使用， 和心理社会因素，是可以改变的，是预防房颤的潜在靶点。敏感度的使用 和无偏见的方法来检测房颤和室性早搏，并发现这些新的可改变的危险因素 心律失常，可能为改善非洲人的心血管疾病(CVD)预防提供机会 美国人。我们的项目将使用一种非侵入性的心电监测设备，它既能很好地- 耐受性和敏感性用于检测亚临床心律失常，以测量亚临床房颤、房颤类型(阵发性与 持久性)，以及SVE频率。在这项辅助研究中，我们建议进行14天的连续心电 对返回参加杰克逊心脏研究(JHS)第四场田野中心考试的2000名参与者进行监测，这是一项大型 非裔美国人心血管疾病危险因素的前瞻性队列研究。我们还将使用预期中的数据 外地中心考试的合同资助部分，包括认知评估和脑磁学 磁共振成像(MRI)。我们的目标是评估亚临床房颤和SVE的人群负担。 非洲裔美国人，并确定亚临床房颤和室性早搏的相关性可能是可改变的危险因素或 这些心律失常的后果。有四个目标。目标1：估计特定于年龄和性别的 JHS中非裔美国人中亚临床房颤和房颤类型(阵发性与持续性)的流行率， 并与接受14天治疗的白人参与者中亚临床房颤和房颤类型的患病率进行比较 连续心电监测在动脉粥样硬化及其风险的多种族研究中的应用 社区研究。目的2：使用JHS考试1-4的数据，(A)评估传统房颤危险因素 与亚临床房颤和室上性心动过速相关，以及(B)确定这些心律失常的新的、可改变的危险因素。 目的3：评估临床房颤风险评分、NT-proBNP水平和从目标2确定的危险因素的实用性 以预测亚临床房颤的发生。目的4：在横断面分析中，确定亚临床房颤和 SVE与认知功能较差和脑MRI异常有关。该项目将生成 有关亚临床房颤和室上性早搏的新知识将与患者相关，并将为预防提供信息 以及减轻非裔美国人房颤负担和房颤相关并发症的治疗策略。

ABSTRACT Atrial fibrillation (AF) is a common arrhythmia that can have devastating consequences, including stroke and accelerated decline in cognitive function. Because AF is often asymptomatic and escapes clinical detection (subclinical AF), conventional methods for identifying AF have underestimated the population burden of AF. African Americans have a lower risk of clinically-recognized AF than whites, yet they suffer more stroke and cognitive impairment. A high prevalence of subclinical AF and of another important arrhythmia, supraventricular ectopy (SVE), may help to explain this paradox. In addition, several emerging risk factors for AF and SVE, including long-term changes in blood pressure, hypokalemia, the use of certain medications, and psychosocial factors, are modifiable and represent potential targets for AF prevention. The use of sensitive and unbiased methods to detect AF and SVE, and the discovery of novel modifiable risk factors for these arrhythmias, may offer opportunities for improved cardiovascular disease (CVD) prevention among African Americans. Our project will use a non-invasive electrocardiographic (ECG) monitoring device that is both well- tolerated and sensitive for detecting subclinical arrhythmia to measure subclinical AF, AF type (paroxysmal vs. persistent), and SVE frequency. In this ancillary study, we propose to conduct 14-day continuous ECG monitoring on 2,000 participants who return for Field Center Exam 4 of the Jackson Heart Study (JHS), a large prospective cohort study of CVD risk factors in African Americans. We will also use data from anticipated contract funded components of the Field Center Exam, including cognitive assessments and brain magnetic resonance imaging (MRI). Our goals are to assess the population burden of subclinical AF and SVE among African Americans, and to identify correlates of subclinical AF and SVE that may be modifiable risk factors or consequences of these arrhythmias. There are four aims. Aim 1: Estimate the age- and sex-specific prevalence of subclinical AF and AF type (paroxysmal vs. persistent) among African Americans in the JHS, and compare with the prevalence of subclinical AF and AF type among white participants undergoing 14-day continuous ECG monitoring in the Multi-Ethnic Study of Atherosclerosis and the Atherosclerosis Risk in Communities Study. Aim 2: Using data from JHS Exams 1-4, (a) evaluate whether traditional AF risk factors are associated with subclinical AF and SVE, and (b) identify novel, modifiable risk factors for these arrhythmias. Aim 3: Evaluate the utility of a clinical AF risk score, NT-proBNP levels, and risk factors identified from Aim 2 for the prediction of subclinical AF. Aim 4: In cross-sectional analyses, determine whether subclinical AF and SVE are associated with worse cognitive function and with brain MRI abnormalities. This project will generate new knowledge about subclinical AF and SVE that will be relevant to patients, and that will inform prevention and treatment strategies to reduce the burden of AF and AF-related complications among African Americans.