Atrial Cardiomyopathy Refines Cardiovascular Mortality Risk Across Cardiometabolic Risk Factor Burden
- 1Epidemiological Cardiology Research Center (EPICARE), Department of Cardiovascular Medicine, Wake Forest University School of Medicine
Abstract
BackgroundElectrocardiographic markers of atrial cardiomyopathy (AtCM) are associated with adverse cardiovascular outcomes. Whether AtCM further refines cardiovascular disease (CVD) mortality risk across increasing cardiometabolic risk factor (CMRF) burden is unclear.
MethodsWe analyzed 7,083 adults free of baseline CVD. AtCM was defined by the presence of [≥]1 ECG marker: prolonged P-wave duration [≥]120 ms in lead II, abnormal P-wave axis outside 0{degrees}-75{degrees}, or deep terminal negativity of the P wave in V1 <-100 V. CMRF burden was defined as the presence of 0, 1, or [≥]2 of hypertension, diabetes, and obesity. CVD mortality was ascertained through December 31, 2006.
ResultsAmong 7,083 participants (mean age 58 years and 48% men), CVD mortality rates increased progressively across the six combined exposure groups. In a multivariable adjusted Cox proportional hazard analysis, AtCM identified higher-risk subgroups within each CMRF burden category, with risk increasing progressively across combined exposure groups and highest among participants with [≥]2 risk factors and AtCM (HR 2.25, 95% CI 1.75-2.87). In secondary analyses, a similar pattern was observed for individual CMRFs, with the combination of AtCM and hypertension, diabetes, or obesity conferring the highest risk compared with participants with neither condition (HR (95% CI): 1.58 (1.31-1.89); 2.08 (1.62-2.68); and 1.47 (1.19-1.82), respectively).
ConclusionsECG-defined AtCM refined CVD mortality risk across increasing CMRF burden. Individuals with both AtCM and multiple CMRFs had the highest risk. These findings support the potential role of ECG-based AtCM assessment as a scalable approach to improve cardiovascular risk stratification among individuals with CMRFs.
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BibTeX
@misc{mohsen2026atrial,
title = {{Atrial Cardiomyopathy Refines Cardiovascular Mortality Risk Across Cardiometabolic Risk Factor Burden}},
author = {A. M. Mohsen and M. Elnewishy and T. Zaho and P. Cheon and B. C. Boursiquot and P. A. Chevli and R. Kazibwe and P. D. Bhave and E. Z. Soliman},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.09.26362666},
url = {https://www.medrxiv.org/content/10.64898/2026.09.09.26362666v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Atrial Cardiomyopathy Refines Cardiovascular Mortality Risk Across Cardiometabolic Risk Factor Burden
AU - A. M. Mohsen
AU - M. Elnewishy
AU - T. Zaho
AU - P. Cheon
AU - B. C. Boursiquot
AU - P. A. Chevli
AU - R. Kazibwe
AU - P. D. Bhave
AU - E. Z. Soliman
PY - 2026
DA - 2026/09/09
PB - medRxiv
DO - 10.64898/2026.09.09.26362666
UR - https://www.medrxiv.org/content/10.64898/2026.09.09.26362666v1
AB - BackgroundElectrocardiographic markers of atrial cardiomyopathy (AtCM) are associated with adverse cardiovascular outcomes. Whether AtCM further refines cardiovascular disease (CVD) mortality risk across increasing cardiometabolic risk factor (CMRF) burden is unclear. MethodsWe analyzed 7,083 adults free of baseline CVD. AtCM was defined by the presence of [≥]1 ECG marker: prolonged P-wave duration [≥]120 ms in lead II, abnormal P-wave axis outside 0{degrees}-75{degrees}, or deep terminal negativity of the P wave in V1 <-100 V. CMRF burden was defined as the presence of 0, 1, or [≥]2 of hypertension, diabetes, and obesity. CVD mortality was ascertained through December 31, 2006. ResultsAmong 7,083 participants (mean age 58 years and 48% men), CVD mortality rates increased progressively across the six combined exposure groups. In a multivariable adjusted Cox proportional hazard analysis, AtCM identified higher-risk subgroups within each CMRF burden category, with risk increasing progressively across combined exposure groups and highest among participants with [≥]2 risk factors and AtCM (HR 2.25, 95% CI 1.75-2.87). In secondary analyses, a similar pattern was observed for individual CMRFs, with the combination of AtCM and hypertension, diabetes, or obesity conferring the highest risk compared with participants with neither condition (HR (95% CI): 1.58 (1.31-1.89); 2.08 (1.62-2.68); and 1.47 (1.19-1.82), respectively). ConclusionsECG-defined AtCM refined CVD mortality risk across increasing CMRF burden. Individuals with both AtCM and multiple CMRFs had the highest risk. These findings support the potential role of ECG-based AtCM assessment as a scalable approach to improve cardiovascular risk stratification among individuals with CMRFs.
ER -