Daily Cardiology Research Analysis

Electronic health records, biobanks, and wearable biosensors enable the collection of multiple health modalities from many individuals. Access to multimodal health data provides a unique opportunity for genetic studies of complex traits because different modalities relevant to a single physiological system (e.g., circulatory system) encode complementary and overlapping information. We propose a multimodal deep learning method, multimodal representation learning for genetic discovery on low-dimensional embeddings (M-REGLE), for discovering genetic associations from a joint representation of complementary electrophysiological waveform modalities. M-REGLE jointly learns a lower representation (i.e., latent factors) of multimodal physiological waveforms using a convolutional variational autoencoder, performs genome-wide association studies (GWASs) on each latent factor, then combines the results to study the genetics of the underlying system. To validate the advantages of M-REGLE and multimodal learning, we apply it to common cardiovascular modalities (photoplethysmogram [PPG] and electrocardiogram [ECG]) and compare its results to unimodal learning methods in which representations are learned from each data modality separately but are statistically combined for downstream genetic comparison. M-REGLE identifies 19.3% more loci on the 12-lead ECG dataset, 13.0% more loci on the ECG lead I + PPG dataset, and its genetic risk score significantly outperforms the unimodal risk score at predicting cardiac phenotypes, such as atrial fibrillation (Afib), in multiple biobanks.

BACKGROUND: Variable evidence exists about the efficacy of Cardiac resynchronization therapy (CRT) in women vs. men with reduced left ventricular ejection fraction (LVEF) and wide QRS complex. Current guidelines, hindered by underrepresentation of women in clinical trials, lack definitive recommendations. The present study was designed to achieve an equal distribution of women and men to prospectively evaluate sex-specific response to CRT. METHODS: The primary endpoint was the absolute increase in core-lab-assessed LVEF 12 months after de novo implantation of a CRT device. Estimation was adjusted by several baseline confounders to correct sex-specific effect of CRT. Secondary endpoints were further echocardiographic changes including responder rate (LVEF increase ≥5 %); change in NYHA class, 6-min walk distance, quality of life, a clinical composite score (CCS) and the composite of death or HF hospitalization. RESULTS: We enrolled 230 women and 244 men at 25 sites in eight countries. A larger improvement in LVEF (+14.7 % vs. +11.5 %, p ≤ 0.01) in women remained after adjustment for baseline variables (absolute increase attributed to female sex +2.53 %, P = 0.023). Furthermore, a better improvement was observed in reverse remodeling, responder rate (∆LVEF ≥5 %: 83.3 % vs. 70.6 %; p = 0.003), quality of life and HF symptoms in women compared to men. The CCS and the composite of death or HF hospitalization were better in women than in men after CRT. CONCLUSIONS: The effect of CRT remained superior in women regarding echocardiographic outcomes even after adjusting for baseline variables. Our results confirm the importance of recognizing sex-specific differences when screening patients for CRT.

BACKGROUND: The optimal timing of undergoing catheter ablation for patients with atrial fibrillation (AF) remains uncertain. We aimed to investigate the impact of diagnosis-to-ablation time (DAT) on AF recurrence and major adverse cardiovascular and cerebrovascular events (MACCE) following catheter ablation. METHODS: This study analyzed prospective observational data from a single center, including 2097 participants (59.98 ± 10.57 years, 62.7% male) undergoing AF ablation between January 2016 and December 2020. Patients were stratified by DAT: ≤ 1 year, > 1 to ≤ 3 years, and > 3 years. Cox proportional hazards and logistic regression analyses were used to identify predictors of AF recurrence and MACCE. RESULTS: During the 46.89 ± 16.46 months follow-up, AF recurs in 512 patients (24.6%). A longer delay per month is significantly associated with a higher recurrence of AF based on multivariable Cox regression analysis [Hazard Ratio (HR) 1.003 (95% CI: 1.001-1.005), p = 0.015]. This association remains consistent in patients with persistent AF (HR compared to DAT ≤ 1 year: 1.548 [95% CI: 1.139-2.102], p = 0.016), but not in those with paroxysmal AF. Left atrial diameter ≥40 mm and female are identified as independent predictors of AF recurrence. The overall impact of DAT on MACCE occurrence is not significant, with age and vascular disease being independent predictors. CONCLUSIONS: Early catheter ablation is preferable for maintaining sinus rhythm, particularly in persistent AF. However, DAT dose not influence the incidence of MACCE. These findings endorse the paradigm shift towards early ablation. For patients with atrial fibrillation (AF), a common type of irregular heartbeat, understanding the ideal time to perform catheter ablation, a minimally invasive treatment that uses energy to correct abnormal heart rhythms, is key. In this study, we followed over 2000 patients with AF for about 4 years to see how timing affected treatment success. Findings show patients who had catheter ablation within 3 years of diagnosis were less likely to have their AF return, especially those with long-lasting AF. The study also found women and patients with larger left atrial chambers of the heart had higher risks of their AF returning. These findings suggest earlier catheter ablation helps maintain a normal heart rhythm and can help doctors and patients make more informed decisions about treatment timing.