BACKGROUND:Low socioeconomic status (SES) is linked to increased cardiovascular risk, but its association with carotid atherosclerosis in the general population is less well studied. We examined associations between individual-level and area-level SES and carotid plaque burden and explored potential sex differences. METHODS:In this cross-sectional analysis from the Akershus Cardiac Examination 1950 Study, individual-level SES was defined by educational attainment, and area-level SES by urban versus rural residence and median household income of municipality. Carotid ultrasound was used to quantify plaque burden with a plaque score (0-3 per segment; maximum 24), where >3 indicates elevated cardiovascular risk. Associations between SES and plaque score were estimated using Poisson regression in crude and adjusted models. RESULTS:We included 3673 participants (48.8% women; mean age 63.9 years). The prevalence of elevated plaque score (>3) was 23.3% in tertiary, 28.2% in secondary and 31.4% in primary education groups (p for trend <0.001). Women and men with primary education had 32% and 24% higher plaque scores than those with tertiary education (p<0.001). After adjustment for cardiovascular risk factors, excess atherosclerotic burden remained 22% in women and 12% in men (p<0.001). No significant associations were observed for area-level SES, and no sex interactions were detected. CONCLUSION:Lower educational attainment is associated with higher carotid atherosclerotic burden in both sexes, independent of cardiovascular risk factors, while area-level SES shows no clear association. These findings suggest that educational disparities contribute to atherosclerotic disease burden and merit further investigation in longitudinal studies.

AIMS:Better control of modifiable risk factors offers substantial potential to prevent cardiovascular disease (CVD). Risk scores can be used to identify and quantify risk and for health promotion, based on prediction of CVD. We aimed to evaluate and compare the prognostic value of Life's Essential 8 (LE8) and its components, and to contrast LE8 with the established risk prediction tool SCORE2. METHODS:The Akershus Cardiac Examination 1950 (ACE1950) Study is an ongoing prospective birth cohort study including all men and women born in 1950 residing in Akershus County, Norway. Calculation of Life's Essential 8 (LE8) and SCORE2 was performed at the baseline visit (2012-2015). Participants were followed through 2022 for incident major adverse cardiovascular events (MACE). RESULTS:Among 3,706 participants (attendance rate 64%), 2,938 without established CVD and with complete LE8 data were included. Mean age 63.9 years, 53% women, with a mean SCORE2 of 6.1 and a LE8 score of 63.9. Only 9.8% had "Optimal" cardiovascular health (CVH) according to LE8. During a median follow-up of 8.3 years, 6.7% experienced incident MACE. Both LE8 (total score, domains, and number of optimal components) and SCORE2 were significantly associated with MACE, with comparable predictive performance (LE 8 HR 1.53, 95% CI 1.35-1.73; SCORE 2 HR 1.82, 95% CI 1.57-2.10, p for comparison = 0.30). The highest risk was observed among participants with "Poor" CVH. CONCLUSIONS:LE8 can be used in health promotion based on prognostic value comparable to SCORE2, for counselling to a healthier lifestyle to preserve cardiovascular health.

Investigate the relationship between myocardial fibrosis and left ventricular (LV) deformation and mechanical synchrony using state-of-the-art cardiac magnetic resonance imaging (CMR) in an elderly general population. In 200 participants without known coronary artery disease, all born in 1950, diffuse fibrosis was quantified by septal extracellular volume (ECV) fraction and focal fibrosis by late gadolinium enhancement (LGE). LV global longitudinal and circumferential strain (GLS, GCS) and mechanical dispersion (MD) were derived by CMR-feature tracking (CMR-FT). Myocardial deformation was also assessed using fast strain-encoded MR (fSENC) percentage of LV segments with normal longitudinal and circumferential strain (≤ -17

Atrial fibrillation is associated with both clinical stroke and covert brain infarction (CBI). Atrial cardiomyopathy has been proposed in absence of atrial fibrillation as an independent stroke risk factor, but supporting evidence is limited. This study aimed to investigate the association between echocardiographic and biochemical markers of atrial cardiomyopathy and the presence of CBI on magnetic resonance imaging (MRI) in an elderly population-based cohort. In the Akershus Cardiac Examination 1950 Study, transthoracic echocardiography and biobanking were performed at first visit (2012–2015). Markers of atrial cardiomyopathy included echocardiographic body surface area-indexed left atrial maximum and minimum volume, left atrial reservoir and contractile strain, and N-terminal pro B-type natriuretic peptide (NT-proBNP). Brain MRI was performed in a subset of participants (2016–2024), that were drawn according to participation in another study and stratified by blood pressure at age 40. Of 3706 participants, 414 (11

ABSTRACT BACKGROUND In line with International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) recommendations for high-sensitivity cardiac troponin assays, analytical validation and reference limit assessments are required to confirm that an assay meets performance criteria. This study evaluated the analytical performance and established the 99 th percentile upper reference limit (URL) for the SPINCHIP ® High-Sensitivity Cardiac Troponin I (“SPINCHIP hs-cTnI”) point-of-care assay. METHODS Analytical performance characteristics, including the limit of blank (LoB), limit of detection (LoD), and limit of quantification (LoQ), were assessed. Additionally, 1053 plasma samples and 1055 whole-blood samples were used to determine the URL. Imprecision around the 99 th percentile URL was evaluated as part of the analytical validation. High-sensitivity criteria were assessed by confirming measurable cTnI in ≥50% of healthy individuals (n=432 plasma; n=431 whole blood) and achieving imprecision <10% at the 99th percentile (plasma, n=960; whole blood, n=480). RESULTS SPINCHIP hs-cTnI demonstrated a LoB of 0.3 ng/L; LoDs of 0.8 ng/L (plasma) and 0.9 ng/L (whole blood); and LoQs of 1.1 ng/L (plasma) and 1.4 ng/L (whole blood). The analytical measuring range was 1.1–9000 ng/L. Imprecision at the common 99th percentile URL (14 ng/L) was 5.8%; for men (URL=16 ng/L) 5.6% and for women (URL=10 ng/L) 6.3%. Greater than 85.2% (94.0% and 76.1% in men and women, respectively) of healthy individuals showed measurable cTnI above the LoD. CONCLUSIONS The SPINCHIP hs-cTnI assay meets the IFCC high-sensitivity requirements, demonstrating <10% imprecision at the 99th percentile, reliable low-concentration precision. and cTnI detection in more than half of healthy individuals. IMPACT STATEMENT High-sensitivity cardiac troponin assays must demonstrate exceptional analytical rigor to ensure clinicians can rely on them for timely and accurate detection of myocardial injury. This study provides a comprehensive analytical validation of the SPINCHIP ® hs-cTnI point-of-care assay to confirm that it meets key International Federation of Clinical Chemistry and Laboratory Medicine high-sensitivity criteria, including precise quantification at the 99th percentile and detection of measurable cardiac troponin concentrations in the majority of healthy individuals. These findings establish the assay’s analytical robustness and support its potential to deliver rapid, trustworthy cardiac troponin results at the point-of-care, helping streamline clinical decision making where speed and accuracy are critical.

BACKGROUND:Cardiac myosin binding protein C (cMyC) is a cardiac-specific biomarker that is released after acute ischemic myocardial injury. Cardiac troponins are established cardiac biomarkers of myocardial injury and provide prognostic information in patients with cardiovascular disease (CVD) and in healthy persons from the general population. There is limited data documenting the prognostic value of cMyC in a general population setting. Accordingly, we assessed the prognostic value of cMyC for incident major adverse cardiovascular events (MACE) and mortality in a general population cohort and contrasted these associations with those of cardiac troponins. METHODS:We measured cMyC, high-sensitivity cardiac troponin I (hs-cTnI), and high-sensitivity T (hs-cTnT) in serum samples from 3682 community dwellers born in 1950 at the baseline of the Akershus Cardiac Examination 1950 Study obtained from 2012 to 2015. We assessed the associations of all three biomarkers with a composite MACE outcome (nonfatal myocardial infarction, nonfatal ischemic stroke, nonfatal heart failure, myocardial revascularization, or cardiovascular mortality), as well as with all-cause, cardiovascular and non-cardiovascular mortality separately. RESULTS:The median age was 63.9 years and 1885 were male. After a median follow-up of 8.3 years, we recorded 307 composite MACE outcomes and 191 deaths. cMyC was associated with risk of MACE, as was hs-cTnI and hs-cTnT (all P for log-rank test <0.001). cMyC remained independently associated with MACE (hazard ratio per 1 SD in log-transformed biomarker 1.25, 95% CI, 1.14-1.37) and cardiovascular death (hazard ratio 1.41, 95% CI 1.15-1.72) in adjusted analyses and after further adjustment for hs-cTnI or hs-cTnT. CONCLUSIONS:cMyC provides strong prognostic information for incident CVD in the general population, independently of that provided by cardiac troponins.

Abstract Background and aims Pulsatility index (PI) and mean velocity flow (MVF) in the M1 segment of the middle cerebral artery (MCA), measured by transcranial color-coded duplex sonography (TCD) through the transtemporal window, have been reported to be altered in individuals with cognitive impairment. This study aimed to investigate whether cerebral blood flow parameters are associated with cognitive test performance in a middle-aged birth cohort without known cognitive impairment. Methods We performed a cross-sectional analysis of the visit of the Akershus Cardiac Examination 1950 study (2012-2015). All inhabitants born in 1950 and residing in Akershus County, Norway, were invited; 3706 (attendance rate 64%) participated. Of these, 2920 completed both TCD examination and the Montreal Cognitive Assessment (MoCA), Delayed recall, and Trail Making Test (TMT) A and B. Test scores were analyzed individually and combined into a dichotomized outcome (normal/abnormal) based on the z-scores. Linear and logistic regression analyses were used to examine associations. Results Mean age (SD) was 63.9 (0.64) years, and 42.8% were women. The mean MVF was 38.3 (11.2) cm/s, and the mean PI was 0.97 (0.17). The mean MoCA score was 25.3±2.8, mean TMT B time was 96.6 ±49.9 seconds, and 1620 (55.5%) scored ≥-1,5 SD below the Norwegian age-adjusted norm on at least one cognitive test. No significant associations were found between MFV or PI and cognitive test scores or the combined cognitive outcome (Figure 1). Conclusions In a middle-aged cohort from the general population, TCD-derived PI and MVF were not associated with cognitive test performance. Conflict of interest Nothing to disclose Figure 1 - belongs to Results

This study investigated how cardiovascular magnetic resonance feature tracking (CMR-FT)-derived myocardial mechanics, beyond global longitudinal strain (GLS), relate to left ventricular ejection fraction (LVEF) and left ventricular mass index (LVMI). In 186 community-dwelling individuals, global circumferential and longitudinal CMR-FT metrics were extracted, including strain, strain rates, displacement, velocities, time-to-peak measures, mechanical dispersion. Univariate associations with LVEF and LVMI were assessed using Spearman correlation. Multivariable associations between a broad set of mechanical metrics and LVEF and LVMI were evaluated using supervised machine-learning models interpreted with Shapley Additive Explanations (SHAP). Among 17 mechanical metrics, the strongest correlated with LVEF were global circumferential strain (GCS, ρ = -0.71), longitudinal systolic strain rate (sSRlong, ρ = -0.53), circumferential diastolic strain rate (dSRcirc, ρ = 0.50), and GLS (ρ = -0.48) (all p < 0.001). In multivariable models, GCS and sSRlong remained most influential for LVEF, with GLS dropping to least influential (SHAP rank #17/17). For LVMI, longitudinal diastolic strain rate (dSRlong) showed the strongest univariate association (ρ = -0.50), followed by GLS (ρ = 0.41) and dSRcirc (ρ = -0.40) (all p < 0.001). SHAP ranked dSRlong and dSRcirc highest, followed by GLS. These findings indicate that feature importance in multivariable SHAP analyses differed from univariate correlation rankings, suggesting that metrics substantially correlated with LVEF or LVMI may contribute less information once myocardial mechanics are considered jointly. LVEF was most strongly associated with GCS and peak systolic strain rate, while LVMI with peak diastolic strain rates and GLS. Future work should test whether integrated mechanical profiles offer added prognostic and diagnostic value beyond single-metric biomarkers.

Background Current expert consensus statements generally suggest cardiovascular risk assessment, including atrial fibrillation (AF) screening, on detection of covert brain infarctions (CBIs). However, evidence to guide management of CBI remains limited. In the absence of randomised clinical trials specifically targeting CBI populations, observational studies comparing individuals with and without CBI can provide insights into the prevalence and burden of cardiovascular risk factors.Objectives We aimed to compare the burden of atherosclerosis and cardiovascular risk factors in participants with CBI to those without, and to explore the yield of AF screening in individuals with CBI.Design A prospective population-based birth cohort study including men and women born in 1950 and resident in Akershus County, Norway.Setting The two hospitals serving the population of Akershus county, Norway.Participants Participants included in the Akershus Cardiac Examination (ACE) 1950 study who also underwent a subsequent MRI examination were eligible for this study.Outcome measures Cardiovascular risk assessment was performed at study inclusion (2012–2015). Carotid ultrasound was used to quantify atherosclerosis through a carotid plaque score, and CHA₂DS₂-VA and Systematic COronary Risk Evaluation 2 (SCORE2) scores were calculated to estimate cardiovascular risk. Brain MRI was performed in a randomly selected, blood pressure-stratified subset of participants (2016–2024). CBI was defined as focal lesions consistent with ischaemia in the absence of clinical stroke. Participants with CBI were offered 72-hour ambulatory ECG monitoring for AF detection.Results MRI was performed in 414 of 3706 (11%) participants in the ACE 1950 Study. The mean age at the time of the MRI examination was 70.2±2.3 years, and 165 (41%) were women. CBI was identified in 54 participants (13%), of whom 45 (83%) completed 72-hour ambulatory ECG monitoring. There were no differences in mean carotid plaque score, SCORE2 or CHA₂DS₂-VA score between participants with CBI compared with those with normal MRI findings. AF was detected in one (2%) participant with CBI.Conclusions In this community-based cohort of individuals in late midlife, individuals with CBI did not have an increased cardiovascular risk compared with those without, as indicated by SCORE2, CHA₂DS₂-VA score, age-appropriate carotid plaque burden and a low prevalence of AF.Trial registration number URL: https://www.clinicaltrials.gov. Unique identifier: NCT01555411.

Rare coding genetic variants may exert large effects on risk of common disease, yet their contribution to disease architecture and their utility in gene prioritization remain limited by inadequate sample sizes. Here, we performed a massive-scale rare variant association study (RVAS), analyzing over 1.1 million sequenced participants among which 130,000 had atrial fibrillation (AF). Through a multi-mask burden testing approach, we identified 15 genes significantly associated with AF through rare large-effect variation. Integrative analyses revealed strong convergence between genes implicated by rare and common variation, and highlighted instances where RVAS data may aid in GWAS prioritization. Nevertheless, several RVAS genes were not among GWAS loci ( FAM189A2 , ACTC1 , FNIP1 , FBN1 ), or were not nominated through contemporary GWAS prioritization ( KDM5B , ZFP36L2 ). Finally, we observed that ultra-rare protein-disrupting variants - concentrated in a small number of large-effect size genes - explained at least 2% of AF susceptibility across European and African ancestry groups. These findings refine the genetic architecture of AF, while highlighting the value and cost of RVAS for genomic discovery in common disease.

Atrial fibrillation (AF) is a prevalent and morbid abnormality of the heart rhythm with a strong genetic component. Here, we meta-analyzed genome and exome sequencing data from 36 studies that included 52,416 AF cases and 277,762 controls. In burden tests of rare coding variation, we identified novel associations between AF and the genes MYBPC3, LMNA, PKP2, FAM189A2 and KDM5B. We further identified associations between AF and rare structural variants owing to deletions in CTNNA3 and duplications of GATA4. We broadly replicated our findings in independent samples from MyCode, deCODE and UK Biobank. Finally, we found that CRISPR knockout of KDM5B in stem-cell-derived atrial cardiomyocytes led to a shortening of the action potential duration and widespread transcriptomic dysregulation of genes relevant to atrial homeostasis and conduction. Our results highlight the contribution of rare coding and structural variants to AF, including genetic links between AF and cardiomyopathies, and expand our understanding of the rare variant architecture for this common arrhythmia.

High-sensitive (hs-) cardiac troponin assays provide prognostic information in atrial fibrillation (AF) patients. Few studies have explored the impact of long-term rate control therapy on levels of troponin in AF patients without coronary heart disease and heart failure. This substudy of the RATe control in Atrial Fibrillation (RATAF) II study aimed to compare the effects of six months’ treatment with diltiazem and metoprolol on hs-troponin I (TnI) levels both at rest and during exercise testing in patients with permanent AF. This was a parallel-group, randomized, investigator-blinded clinical trial. The cohort consisted of 93 patients (28 women, mean age 71 ± 7 years) with symptomatic, permanent AF with preserved left ventricular systolic function and no coronary heart disease. Participants were randomized in a 1:1 ratio to receive either diltiazem 360 mg (n = 49) or metoprolol 100 mg (n = 44) once daily for six months. Blood tests were drawn at rest and during peak exercise testing at baseline, one month and six months’ treatment. This research has been supported by grants from the South-Eastern Norway Regional Health Authority and Vestre Viken Hospital Trust. Six months’ treatment with diltiazem and metoprolol significantly lowered the heart rate at rest and peak exercise. Both treatment groups exhibited a decrease in hs-TnI levels at rest (diltiazem p = 0.008, metoprolol p = 0.03) and peak exercise (diltiazem p < 0.001, metoprolol p = 0.004) at six months compared to baseline levels, with no significant differences observed between the groups. In patients with permanent AF, six months of rate control therapy with diltiazem or metoprolol lowered levels of hs-TnI. Further research is warranted to determine whether this reduction translates into an improved prognosis. NCT02695992. Registration date: 2015–04-28.

Background Myocardial fibrosis is associated with a poor outcome for patients with cardiovascular disease (CVD). Growth differentiation factor 15 (GDF-15) concentrations predict the risk of death in patients with CVD, but the underlying pathophysiological mechanisms are poorly understood. We aimed to assess the associations between biomarkers of cellular stress and inflammation (GDF-15), cardiac injury (cardiac troponin T [cTnT]), and stretch (N-terminal pro-B-type natriuretic peptide [NT-proBNP]), and subsequent focal and diffuse myocardial fibrosis assessed by cardiac magnetic resonance (CMR) imaging.Methods We measured GDF-15, cTnT, and NT-proBNP in 200 study participants without known coronary artery disease or renal dysfunction from the population-based Akershus Cardiac Examination 1950 Study at baseline in 2012 to 2015. Focal myocardial scars and diffuse fibrosis were assessed by late gadolinium enhancement imaging and septal extracellular volume fraction (ECV) by CMR 4 to 7 years later. The relationships between cardiac biomarkers and CMR parameters were assessed by logistic regression analysis adjusted for common cardiovascular risk factors.Results The median age was 63.9 (interquartile range 63.4-64.5) years and 49% were women. GDF-15 (adjusted odds ratio [aOR] 4.40, 95% CI 1.09-17.72) and cTnT (aOR 1.59, 95% CI 1.01-2.50) were associated with nonischemic scars in the fully adjusted model. cTnT (aOR 2.45, 95% CI 1.41-4.25) and NT-proBNP (aOR 3.12, 95% CI 1.55-6.28) were associated with ischemic scars. None of the biomarkers were significantly associated with elevated ECV.Conclusions In a general population cohort, GDF-15, an emerging biomarker of cellular stress and inflammation, associates with nonischemic scars. Biomarkers of myocardial injury and stretch associate with ischemic scars, while no biomarker was associated with diffuse fibrosis as assessed by CMR.

The separate effects of systolic (SBP) and diastolic blood pressure (DBP) on cerebral small vessel disease (cSVD) development needs elucidation. We investigated the association between SBP and DBP at age 40 and two selected brain magnetic resonance imaging (MRI) features of cSVD (lacunes and white matter hyperintensities [WMHs]) at age 70 in a general Norwegian population cohort. We included individuals from the Akershus Cardiac Examination (ACE) 1950 Study (2012–2015) who had previously participated in the Age 40 Program (1990–1993). A random subset of participants with SBP in the categories of non-elevated (< 120 mmHg), high elevated (130–139 mmHg) or hypertension (≥ 140 mmHg) at age 40 were invited to perform brain MRI for assessment of cSVD (lacunes and WMHs) at age 70 (2016–2024). DBP was categorized as non-elevated (< 70 mmHg), low elevated (70–79 mmHg), high elevated (80–89 mmHg) and hypertension (≥ 90 mmHg). Logistic and ordinal regressions assessed the association between SBP and DBP and lacunes and severity of WMHs (measured with Fazekas scale), adjusting for sex, total cholesterol, smoking, physical activity, diabetes, education, and age at MRI, with non-elevated BP as the reference category. A total of 414 participants (167 [40 Figure developed by the authors using venngage.com with a license to use, reproduce and distribute worldwide. ACE, Akershus Cardiac Examination. BP, blood pressure. DBP, diastolic blood pressure. MRI, magnetic resonance imaging. WMHs, white matter hyperintensities.

INTRODUCTION:Atrial fibrillation is the most prevalent sustained arrhythmia worldwide and is expected to increase substantially within the coming years. Although lifestyle changes and risk factor modification are now acknowledged as central components of atrial fibrillation management, the effects of exercise on disease-specific outcomes are still not extensively documented due to few high-quality randomised trials. The primary objective of the Norwegian Exercise in Atrial Fibrillation Trial (NEXAF) is to assess the effects of exercise over 12 months on key clinical and patient-reported outcomes in previously inactive patients with atrial fibrillation. METHODS AND ANALYSIS:NEXAF is a multicentre, two-arm, randomised controlled trial inviting patients 18-80 years with a confirmed diagnosis of paroxysmal or persistent atrial fibrillation. Eligible patients are randomised 1:1 to either a combined supervised and eHealth-based exercise intervention or usual care for 12 months. The primary outcomes are total time in atrial fibrillation measured by insertable cardiac monitors, and disease-specific quality of life measured by the Atrial Fibrillation Effect on Quality-of-Life questionnaire. ETHICS AND DISSEMINATION:Ethical approval was obtained from the Regional Ethics Committee in Mid-Norway in April 2021 (ID 213848). TRIAL REGISTRATION NUMBER:NCT05164718.

BACKGROUND:The life-long exposure of the left heart chambers to systemic blood pressures may be important to changes in left atrial (LA) function with age, but long-term follow-up studies are scarce. We aimed to assess the impact of blood pressure in mid-life on LA function assessed by echocardiographic reservoir (LASr) and contractile (LASct) strain two decades later, in men and women. METHODS:Echocardiography was performed at ages 62-65 in 3706 participants born in 1950 of the prospective observational Akershus Cardiac Examination (ACE) 1950 Study. Data was linked with blood pressure measurements from the Age 40 Programme, a national health survey performed when the participants were 40-43 years of age. Participants were categorised into three groups representing normal blood pressure, elevated blood pressure and hypertension, based on measurements at ages 40-43. Linear regression models were used to assess associations between blood pressure and echocardiographic LA strain analysis. RESULTS:A total of 2399 participants (51.6% women) had available LA strain analysis from the ACE 1950 Study (mean age 63.9±0.6 years) and blood pressure data from the Age 40 Programme (mean age 40.1±0.3 years). At ages 62-65, mean LASr was 35.1±9.2% and LASct was 17.7±5.6%. Adjusted regression models showed a significant association between blood pressure category increase at ages 40-43 and LASct (adjusted β 1.03% (95% CI 0.37% to 1.69%), p=0.002) at ages 62-65, but not with LASr. In women, no associations were evident between blood pressure at ages 40-43 and LA strain two decades later. CONCLUSIONS:Increased blood pressure in the early 40s was associated with higher LA contractile strain two decades later in men, but not in women.

Objectives The objective of this study was to assess the quality of ECG recordings and the concordance between the automatic detection of cardiac arrhythmia episodes by a patch ECG and an insertable cardiac monitor.Design Prospective cohort study.Setting and participants Endurance athletes diagnosed with paroxysmal atrial fibrillation (AF) and no other relevant comorbidities participating in a randomised controlled trial on the effects of training adaption.Methods A patch ECG (ECG247 Smart Heart Sensor) was sent to 29 non-elite endurance athletes with clinical paroxysmal AF. ECG247 continuously monitors, detects and categorises cardiac arrhythmias. The participants were simultaneously monitored with an insertable cardiac monitor (Confirm Rx, Abbott). ECG recording quality was assessed by an experienced physician. Training sessions were monitored using sports watches.Results Out of 29 invited athletes, 14 athletes (mean age 60.4 years, 2 women) made use of the patch ECG and were monitored for a total of 2987 hours and a median of 14 (range 1–17) days. During this period, the athletes performed a total of 112 training sessions. ECG quality varied between athletes and by type of exercise, with poor quality in 16% and 40% of recordings during cross-country skiing and running, respectively. In two athletes, the patch ECG detected AF episodes that were confirmed with insertable cardiac monitor recordings. One technical artefact was falsely classified as ventricular tachycardia by the ECG247 Smart Heart Sensor system.Conclusion Monitoring with patch ECG was feasible in endurance athletes, but ECG recording quality varied between athletes and by type of exercise.Trial registration NCT04991337 (for the related randomised controlled trial).

Objectives To assess atrial fibrillation (AF) burden, symptoms and quality of life (QoL) in endurance athletes with paroxysmal AF.Design Prospective cohort study.Setting and participants Otherwise healthy endurance athletes with paroxysmal AF in Norway, Australia and Belgium. The current study presents baseline measurements collected before the intervention of a randomised controlled trial on effects of individually tailored training adaptation.Methods AF burden (percentage time in AF) was measured by insertable cardiac monitors (Confirm Rx, Abbott). AF-related symptoms and QoL were assessed using the Atrial Fibrillation Effect on QualiTy-of-Life Questionnaire (AFEQT) with any score <80 defined as clinically relevant.Results 43 athletes (age 57±10 (mean±SD), range 33–75 years, 3 women) were included. The athletes were monitored for 50±18 days. Median AF burden was 0.18% (IQR 0%–2.6%). Out of 29 athletes with at least one AF episode, 21 (72%) had AF episodes >60 min. 13 athletes (30%) had AFEQT overall score <80, indicating reduced QoL, and 23 athletes (53%) had significant symptoms. AF burden above median, and episodes >60 min were associated with reduced QoL (mean AFEQT score 78 vs 90, p=0.001 and 78 vs 90, p=0.001, respectively). There were large individual variations between the athletes concerning AF burden, symptoms and QoL.Conclusions Although most athletes were still competing, more than half had troublesome symptoms. One-third had reduced QoL, which was associated with higher AF burden and longer duration of AF episodes. Variations between the athletes highlight the need for individually tailored AF management in athletes with paroxysmal AF.Trial registration number NCT04991337.

AIMS:Stroke risk in atrial fibrillation (AF) patients increases over time, but the optimal reassessment interval remains unclear. This study evaluated changes in the CHA2DS2-VA score in AF patients with low (score 0) or intermediate (score 1) stroke risk and explored appropriate reassessment intervals. METHODS AND RESULTS:Using Norwegian national registries (2011-18), 40 782 individuals with incident AF aged ≥18 years and a low or intermediate CHA2DS2-VA score were identified. Patients were followed from first AF diagnosis until an increase in the CHA2DS2-VA score, and the proportion with increased score was assessed across age groups. The number needed to reassess to detect one new CHA2DS2-VA risk factor was calculated at different time intervals after AF diagnosis. The CHA2DS2-VA score increased in 50% of patients after a median follow-up of 1.7 years. The proportion of patients with an increased CHA2DS2-VA score was 19% at 6 months, 25% at 1 year, and 40% at 3 years after AF diagnosis. At 1 year, the proportion of patients with a new risk factor was lower in those aged 18-44 years (8%) and 45-54 years (14%) compared to those aged >55 years (30%), with the number needed to reassess at 1 year being 12, 7, and 3 patients, respectively. CONCLUSION:New risk factors emerged in half of AF patients within 1.7 years. Age-specific differences underscore the need for tailored reassessment, suggesting a shorter interval of 6 months for patients ≥55 years and 1 year for those <55 years and routinely at age 65 and 75 years.

BACKGROUND:Cardiac myosin binding protein C (cMyC) is a novel, cardiac-specific biomarker with an early release profile after acute ischemic myocardial injury. Whether cMyC reflects chronic myocardial injury and left ventricular remodelling in the general population is unknown. The aims of the study were to test the hypotheses that cMyC concentrations are associated with cardiovascular risk factors, biomarkers of chronic myocardial injury, and imaging biomarkers of cardiac anatomy, function, and fibrosis. METHODS:Circulating cMyC and cardiac troponin I and T concentrations were measured in 3672 individuals from the general population, born in 1950, who underwent echocardiography. One-hundred-ninety-nine participants with measured cMyC completed a cardiovascular magnetic resonance (CMR) examination for assessment of myocardial fibrosis. RESULTS:Circulating cMyC was measurable in 99.6% of study participants and in 99.0% of CMR substudy participants. cMyC was positively associated with left ventricular mass and left atrial volume and inversely associated with renal function and indices of left ventricular systolic and diastolic function. In participants with available late gadolinium enhancement images for the assessment of focal fibrosis (n = 197), cMyC was positively associated with indices of focal myocardial fibrosis. CONCLUSIONS:In the general population, circulating cMyC concentrations are associated with cardiovascular risk factors, reflect left ventricular remodelling, including focal myocardial fibrosis, and systolic and diastolic dysfunction independently of traditional risk factors.