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Article Abstract
Background: This study evaluates the association between left atrial and right atrial (LA, RA) parameters and a composite endpoint (CEP) of all-cause death, thromboembolism, acute coronary syndrome, and heart failure hospitalization in atrial fibrillation (AF) patients.
Material And Methods: Patients were prospectively enrolled. At baseline, the following echocardiogram parameters were measured: LA and RA antero-posterior diameter index (iLAAPD, iRAAPD), LA and RA volume index (LAVi, RAVi), LA and RA sphericity index (LASI, RASI), LA and RA emptying fraction.
Results: A total of 489 patients (61.3% males) with a median age of 75 (66-80) years and a median CHA2DS2VASc score of 3 (2-5) were enrolled (92.2% receiving anticoagulation). Permanent AF was present in 40.5% of the total cohort. After a median follow-up of 1114 (392-1384) days, 129 patients (26.3%) reached the CEP. The highest sensitivity for CEP was for LA emptying fraction <28% and iRAAPD >24 mm/m2 (72% and 73%, respectively) while the best negative predictive values were for iLAAPD and LAVi (both 81%). Right atrial parameters were not associated with CEP. Discrimination analysis using net reclassification improvement (NRI) showed that iLAAPD and LAVi significantly improved patient reclassification compared to a null model without atrial parameters (iLAAPD NRI 0.30; P = 0.005; LAVi NRI 0.32; P = 0.002). Multivariate Cox regression analysis found that LA dimensions, volume, and function were associated with a higher risk of adverse outcomes and significantly improved risk prediction for the CEP.
Conclusions: LAVi and iLAAPD enhance discrimination and risk prediction for adverse outcomes in AF patients.
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| http://dx.doi.org/10.33963/v.phj.104937 | DOI Listing |
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