Related Experiment Video

Updated: Aug 6, 2026

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
08:10

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation

Published on: July 20, 2022

Association of Left Atrial Structure and Function with Incident Atrial Fibrillation in Black and White Adults: the

Yuchen Li1, Elsayed Z Soliman2, Srishti Shrestha3

  • 1Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.

Medrxiv : the Preprint Server for Health Sciences
|July 17, 2026
PubMed

Insights

Black individuals have lower atrial fibrillation (AF) risk than White individuals. While left atrial (LA) size and function impact AF risk in both groups, they do not explain this racial disparity, highlighting the complexity of AF epidemiology.

Area of Science:

  • Cardiology
  • Epidemiology
  • Racial Health Disparities

Background:

  • Black individuals exhibit lower atrial fibrillation (AF) incidence compared to White individuals, despite a higher prevalence of cardiovascular risk factors.
  • Investigating racial differences in left atrial (LA) structure and function may elucidate the observed AF risk patterns.

Purpose of the Study:

  • To examine the association between echocardiographic measures of LA structure and function and incident AF across racial groups.
  • To determine if LA characteristics explain the lower AF incidence in Black versus White individuals.

Main Methods:

  • Analysis of 4,576 participants (978 Black, 3,598 White) from the Atherosclerosis Risk in Communities (ARIC) study (2011-2021).
  • Utilized race-specific Cox proportional hazards models to assess LA measures and AF incidence, adjusting for covariates.
  • Evaluated the potential for LA measures to attenuate the race-AF risk association.

Main Results:

  • Larger LA size and poorer LA function correlated with increased AF risk in both Black and White participants.
  • Most LA measures showed similar associations across races, except for LA reservoir strain, which was more strongly associated with AF risk in Black individuals.
  • White participants had a higher AF risk (HR 1.59) than Black participants, and this disparity was not significantly reduced by adjusting for LA measures.

Conclusions:

  • LA remodeling (size and function) is a significant predictor of incident AF in both Black and White individuals.
  • However, LA structural and functional differences do not account for the lower AF incidence observed in Black individuals.
  • The Black-White AF paradox remains unexplained by current LA remodeling metrics.
Abstract

Keywords:
Atrial fibrillationechocardiographyepidemiologyleft atriumrace differences

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