Background

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, with significant clinical and economic burdens, largely driven by adverse cardiovascular outcomes and AF-related hospitalization. Left atrial (LA) parameters have been shown to have prognostic value in cardiovascular disease states. We sought to evaluate the prognostic value of measures of LA size and function, as measured through LA volume index and LA emptying fraction (LAEF), respectively, for AF rehospitalization and long-term adverse outcomes in patients with nonvalvular AF following index hospitalization.

Methods

In this retrospective study, 594 consecutive patients (mean age, 67.8 ± 13.6 years, 53% men) admitted to a tertiary referral center with nonvalvular AF were assessed. Patients who underwent transthoracic echocardiography during their index admission and had complete follow-up data were included and followed for a mean period of 33.18 ± 21.27 months for the primary outcome of AF rehospitalization. The secondary outcome was a composite of all-cause death and major adverse cardiovascular events.

Results

The primary outcome occurred in 250 (42%) patients, and the secondary outcome occurred in 219 (37%) patients. On multivariable regression analysis, LAEF had an independent association with AF rehospitalization (hazard ratio [HR] = 0.967; 95% CI, 0.953-0.982; P < .01), and time-dependent receiver operating characteristic curves demonstrated LAEF to have strong diagnostic accuracy in predicting early and intermediate AF rehospitalization. Both LA volume index (HR = 1.014; 95% CI, 1.003-1.026; P = .01) and LAEF (HR = 0.982; 95% CI, 0.970-0.993; P < .01) were associated with all-cause death and major adverse cardiovascular events.

Conclusions

Adverse LA remodeling, as reflected through LA enlargement and reduced LA mechanical function, is associated with AF rehospitalization and long-term adverse cardiovascular outcomes in hospitalized patients with nonvalvular AF.

中文翻译：

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指数住院后非瓣膜性心房颤动患者左心房指标与心房颤动再住院和不良心血管结局的关联

背景

心房颤动 (AF) 是临床实践中最常见的心律失常，具有显着的临床和经济负担，主要由不良心血管结局和 AF 相关住院造成。左心房 (LA) 参数已被证明在心血管疾病状态中具有预后价值。我们试图评估 LA 大小和功能测量值的预后价值，分别通过 LA 体积指数和 LA 排空分数 (LAEF) 测量，用于 AF 再住院和非瓣膜性 AF 患者在指数住院后的长期不良结局。

方法

在这项回顾性研究中，评估了 594 名连续入住三级转诊中心的非瓣膜性 AF 患者（平均年龄 67.8 ± 13.6 岁，53% 为男性）。在首次入院期间接受了经胸超声心动图检查并获得完整随访数据的患者被纳入研究，平均随访时间为 33.18 ± 21.27 个月，主要结局为 AF 再住院。次要结局是全因死亡和主要心血管不良事件的复合结局。

结果

主要结局发生在 250 名（42%）患者中，次要结局发生在 219 名（37%）患者中。在多变量回归分析中，LAEF 与 AF 再住院独立相关（风险比 [HR] = 0.967；95% CI，0.953-0.982；P  < .01），时间依赖性受试者工作特征曲线表明 LAEF 具有很强的诊断能力预测早期和中期 AF 再住院的准确性。LA 体积指数 (HR = 1.014; 95% CI, 1.003-1.026; P  = .01) 和 LAEF (HR = 0.982; 95% CI, 0.970-0.993; P  < .01) 均与全因死亡和主要不良心血管事件。

结论

不利的 LA 重构，表现为 LA 扩大和 LA 机械功能降低，与非瓣膜性 AF 住院患者的 AF 再住院和长期心血管不良结局相关。