Left Atrial Enlargement and Biomarker Profiles: Time for Integration of Biomarkers and Echocardiography in Heart Failure Prevention
Bibliographic record
Abstract
This article refers to ‘Proteomic profiles of left atrial volume and its influence on response to spironolactone: Findings from the HOMAGE trial and STANISLAS cohort’ by M. Kobayashi et al., published in Eur J Heart Fail 2024;26:1231–1241. Left atrial (LA) enlargement insidiously develops following increased left ventricular diastolic pressure and is often considered a marker of diastolic dysfunction.1 LA enlargement in the general population is associated with a higher risk of mortality and risk of developing heart failure (HF) or atrial fibrillation (AF).2 Similarly, measures of LA structure and function are associated with a range of adverse outcomes and risk of rehospitalization in patients with prevalent AF or HF.3,4 Few studies have investigated the biomarker profiles associated with LA volume index (LAVi) in patients without HF or AF, and no studies were designed to show whether mineralocorticoid receptor antagonists (MRAs) can module these pathophysiological pathways. Recently, Kobayashi et al.5 investigated the proteomic profiles associated with LA volume indexed to body surface area and their modulations by spironolactone. The authors presented data from two independent studies. The first, the Heart ‘Omics’ in AGEing (HOMAGE) trial, was a prospective, randomized, open-label, multicentre trial where people at high risk of developing HF were randomized to spironolactone or control.6 All patients in the HOMAGE trial were older, with a minimum age of 60 years, and had either established coronary artery disease or at least two criteria indicating high cardiovascular risk (hypertension, diabetes, microalbuminuria, or an abnormal electrocardiogram). Notably, all patients with prevalent AF, a significant cause of increased LA volume, were excluded at baseline. The authors externally validated the biomarkers associated with increased atrial size in the Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux (STANISLAS), which was a prospective population cohort.7 Patients with AF were also excluded in the STANISLAS validation cohort.
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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 | 0.018 | 0.028 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.007 | 0.009 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
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".