Lin, Grace

Introduction: Graves’ disease (GD) is known to cause menstrual changes and has been linked to infertility in women. This can be due to the increased production of androstenedione and testosterone induced by the excess thyroid hormone. However, screening for sex hormone levels in all women diagnosed with GD to identify patients more likely to have infertility is not cost-effective and not clinically indicated. AI-augmented ECG can identify the signature of female with an AUC of 0.97. In this model, AI- ECG gives a probability number between 0-100% of being female, with higher numbers indicating high probability of being female. Hypothesis: We hypothesized that this inexpensive AI ECG tool is reflective of hormonal levels and the resulting changes in menstrual cycle and fertility associated with GD in women. Methods: Patients diagnosed with GD (2009-2019) at our institution were included. Three intervals were identified: 1) Before GD: >2 months before GD diagnosis 2) During GD: within 2 months before GD and before attaining euthyroidism 3) After GD: after attaining euthyroidism. The matched-pairs t-test was used to compare probability of being a female; patients acted as their own controls. A subset analysis was done on females <45 years at GD diagnosis to study the association between female probability during GD and menstrual changes (defined as shorter, lighter, or newly irregular menstrual cycles). Results: 154 females with ECGs both before and during GD were identified. AI ECG female probability decreased with GD diagnosis (85% vs. 77%, P<.001). On the other hand, 137 females with GD had ECGs during and after GD. Female probability increased after attaining euthyroidism (76% vs 83%, P=.005). Moreover, 72 females <45 years were identified; 30 (42%) developed menstrual changes and had significantly lower AI-ECG female probability [77 (58-94)% vs 98 (92-100)%, P<.001] Conclusions: AI-enabled ECG signature of female gender in women was altered by GD and was associated with menstrual changes, likely reflecting changes in sex hormone levels. Future studies to confirm its role in screening for infertility in women with GD are needed.

Introduction: The predictive value of left atrial (LA) volume and reservoir function (ResF) post-atrial fibrillation (AF) ablation has been scarcely studied. Hypothesis: Abnormal LA volume and ResF post-ablation are associated with adverse cardiovascular events. Methods: We analyzed LA maximum (LAVImax) and minimum (LAVImin) volume index, and 2 measures of ResF, emptying fraction (LAEF) and expansion index (LAEI), prospectively measured at 3-month post-procedure in patients in sinus rhythm who underwent AF ablation between 2007-2016. Composite endpoint (CE) at follow up was all-cause mortality, cardiac hospitalization (heart failure or acute ischemic event) and stroke. Results: 792 patients were studied ( age 60±10 years, 25% women ; Table 1) . Over 7.5 years [IQR 3.0-9.7], 96 (12%) patients experienced CE, which was more prevalent in patients with enlarged LA and reduced ResF. Impaired LA volumes and ResF were each independently associated with CE ( Fig.1 ), even after adjustment for clinical, demographic and echo characteristics (Model A, Fig.2 ) (LAVImax ≥35 ml/m 2 : HR 2.15 [95% CI, 1.35-3.43], p=0.001; LAVImin≥20.5 ml/m 2 : HR 2.88 [1.77-4.69], p<0.0001; LAEF<39%: HR 2.00 [1.31-3.05], p=0.001; LAEI<65%: HR 1.95 [1.27-3.01], p=0.003). ResF measures (LAEF and LAEI) were incremental to LAVImax (all p<0.05), but not LAVImin (all p>0.05; Fig.2 ). In patients with normal LA (LAVImax <35 ml/m 2 ; n=408), increased LAVImin (≥20.5 ml/m 2 ) remained associated with CE (HR 3.11 [1.45-6.67], p=0.004) and cardiac hospitalization (HR 5.81 [1.87-18.01], p=0.002). These findings were independent of AF recurrence. Conclusions: In these patients, enlarged LA and impaired ResF at 3-month post-ablation were strongly associated with adverse cardiovascular outcomes, regardless of AF recurrence. Measures of LA ResF were incremental to LAVImax. Notably, LAVImin showed the strongest associations and even identified a high-risk subgroup among patients with non-dilated LA.

Background Atrial fibrillation (AF) is the most common sustained atrial arrhythmia. One potential target for ablation is left atrial (LA) scar (LAS) regions that may be the substrate for re-entry within the atria, thereby sustaining AF. Identification of LAS through LA delayed gadolinium enhancement (LADE) with MRI has been proposed. Objectives We sought to evaluate LADE in patients referred for catheter ablation of AF. Methods Prospective analysis was conducted of consecutive patients who underwent pulmonary vein antrum isolation (PVAI) ablation for AF at a single institution. Patients underwent LADE with MRI to determine LAS regions before ablation. MRI data were analysed independently in accordance with prespecified institutional protocol by two staff cardiac radiologists to whom patient outcomes were masked, and reports of LADE were documented. Where no initial consensus occurred regarding delayed enhancement (DE), a third staff cardiac radiologist independently reviewed the case and had the deciding vote. Results Of the 149 consecutive patients (mean (SD) age, 59 (9) years), AF was persistent in 64 (43%) and paroxysmal in 85 (57%); 45 (30%) had prior ablation. Only five patients (3%) had identifiable DE in LA walls (persistent AF, n=1; paroxysmal AF, n=4). LADE was present in two (4%) of the 45 patients with previous left PVAI. The presence of LADE was not associated with a higher recurrence rate of AF. Conclusions In contrast to previous studies, the finding of DE within LA walls was uncommon and, when present, did not correlate with AF type or risk of AF recurrence. It therefore is of unclear clinical significance.