Association between markers of left atrial cardiopathy and cognitive decline in the absence of atrial fibrillation
Bibliographic record
Abstract
Abstract Background Whether atrial cardiopathy is independently associated with cognitive impairment in the absence of atrial fibrillation (AF) remains unknown. This longitudinal cohort study aims to investigate associations between markers of left atrial cardiopathy and cognitive decline, and to identify longitudinal trajectories of cognitive decline in aging adults without AF over time. Method A cohort of adults ≥45 years of age with no prior AF or cognitive impairment (N=21,869) was ascertained from the REGARDS (Reasons for Geographic and Racial Differences in stroke) prospective cohort study database. Markers of left atrial cardiopathy included atrial premature complexes (APCs) and N‐Terminal pro‐Brain Natriuretic Peptide (NTpro‐BNP). Cognitive status was measured using Six‐Item Screener (SIS) and an SIS score <5 was defined as cognitive impairment. Cox proportional hazards regression was used to estimate the cause‐specific hazard for primary (cognitive impairment) and secondary outcomes (stroke). Cognitive status trajectories were identified using latent class growth models. Baseline characteristics associated with each trajectory were identified using multinomial logistic regression. Result During a mean follow‐up of 9.9 years, 6,060 participants had incident cognitive impairment and 876 had a stroke. APCs increased the hazard of cognitive impairment by 10% (hazard ratio [HR], 1.10, 95%CI: 1.00‐1.20) and stroke by 9% (HR, 1.09, 95%CI: 1.01‐1.18). Elevated NTpro‐BNP increased the hazard of cognitive impairment by 55% (HR, 1.55, 95%CI: 1.17‐2.04) and stroke by 35% (HR, 1.35, 95%CI: 1.13‐1.60). Three unique cognitive trajectories were identified: while 85% showed a normal and stable trajectory of SIS scores, 13% showed a progressively decreasing trajectory, and 2% showed a dramatic decrease in SIS scores. Age, coronary artery disease, diabetes, and NTpro‐BNP were all associated with worse cognitive trajectories. Conclusion We showed that markers of left atrial cardiopathy including APCs and elevated NTpro‐BNP were associated with an increased risk of cognitive impairment and stroke in the absence of AF. Adults with these markers followed three unique longitudinal cognitive trajectories. These findings indicate that markers of left atrial cardiopathy (APCs and NTpro‐BNP) may have significant implications for early diagnosis and prevention of cognitive impairment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".