Journal of the American Society of Echocardiography
Clinical InvestigationEchocardiography and Atrial FibrillationAssociation of Left Atrial Metrics with Atrial Fibrillation Rehospitalization and Adverse Cardiovascular Outcomes in Patients with Nonvalvular Atrial Fibrillation following Index Hospitalization
Section snippets
Study Population
Between January 2013 and January 2018, 1,372 consecutive patients with a principal diagnosis of AF admitted to our cardiology service at a tertiary referral center were screened. Five hundred ninety-four patients aged >18 years with nonvalvular AF who underwent comprehensive transthoracic echocardiography during the admission and did not have comorbidities limiting life span to less than 12 months were included.
We excluded patients with valvular AF (defined as greater than moderate-to-severe
Study Cohort
The study protocol and patient characteristics are summarized in Figure 1. The mean age of the study cohort was 67.8 ± 13.6 years, and 53% were men. Follow-up was complete in all patients over a mean study period of 33.18 ± 21.27 months.
The majority (70%) of patients had paroxysmal AF, while 30% had persistent/permanent AF. At baseline, 54% had a primary index AF admission, while 46% had a secondary index AF admission. Vascular risk factors were highly prevalent in the study population, with
Discussion
In a cohort of patients hospitalized with nonvalvular AF, we demonstrate alterations in LA function to have an independent association with AF-related rehospitalization. Impaired LAEF was the only echocardiographic measure that was associated with early and intermediate AF rehospitalization, with superior diagnostic performance to LAVI and other echocardiographic metrics of LV function. In addition to known prognostic clinical factors, LAEF was also associated with poor clinical outcomes
Strengths and Limitations
As our study has a retrospective design and study follow-up was limited to information retrieved from medical records via physician correspondence and hospital records, there are inherent limitations relating to potential errors due to inaccurate International Statistical Classification of Diseases coding and incomplete medical records. Despite this, our study evaluated a robust study population and summarized findings with strong biological plausibility.
Conclusion
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. The use of measures of LA remodeling may be helpful to improve risk stratification and early intervention in this population.
References (37)
- et al.
A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study
Am J Med
(2002) - et al.
Coronary heart disease and atrial fibrillation: the Framingham Study
Am Heart J
(1983) - et al.
Drivers of hospitalization in atrial fibrillation: a contemporary review
Heart Rhythm
(2020) Left atrial size and function: role in prognosis
J Am Coll Cardiol
(2014)- et al.
Relationship between left atrial functional measures and incident atrial fibrillation in the general population: the Copenhagen City Heart Study
JACC Cardiovasc Imaging
(2019) - et al.
Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
J Am Soc Echocardiogr
(2015) - et al.
Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
J Am Soc Echocardiogr
(2016) - et al.
Relation of echocardiographic markers of left atrial fibrosis to atrial fibrillation burden
Am J Cardiol
(2018) - et al.
Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter?
J Am Coll Cardiol
(2006) - et al.
Left atrial emptying fraction predicts limited exercise performance in heart failure patients
Int J Cardiol Heart Vessel
(2014)
The analysis of left atrial function predicts the severity of functional impairment in chronic heart failure: the FLASH multicenter study
Int J Cardiol
The impact of atrial fibrillation clinical subtype on mortality
JACC Clin Electrophysiol
Persistent atrial fibrillation from the onset: a specific subgroup of patients with biatrial substrate involvement and poorer clinical outcome
JACC Clin Electrophysiol
Assessing the direct costs of treating nonvalvular atrial fibrillation in the United States
Value Health
Impact of CARDIOrespiratory FITness on arrhythmia recurrence in obese individuals with atrial fibrillation: the CARDIO-FIT Study
J Am Coll Cardiol
Long-term effect of goal-directed weight management in an atrial fibrillation cohort: a long-term follow-up study (LEGACY)
J Am Coll Cardiol
Left atrial strain predicts reverse remodeling after catheter ablation for atrial fibrillation
J Am Coll Cardiol
Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence
Circulation
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Imaging in atrial fibrillation: A way to assess atrial fibrosis and remodeling to assist decision-making
2023, American Heart JournalCitation Excerpt :LA enlargement or dilation may be a marker of the severity of underlying structural heart diseases including hypertension, coronary artery disease, heart failure, or valvular heart disease. But LA size may also act as a marker of long lasting LV diastolic dysfunction, and LA enlargement has been related to hospitalization, cardiovascular outcomes[41], [42], and higher risk of new-onset AF[43–46]. In patients without permanent AF, progression of AF is independently associated with LA dilation, so adding this parameter to clinical scores (e.g. HATCH score) might improve prediction of progression to permanent AF[47].
The Left Atrium Makes Headlines
2023, Journal of the American Society of EchocardiographyAtrial Cardiomyopathy with Impaired Functional Reserve in Patients with Paroxysmal Atrial Fibrillation
2023, Journal of the American Society of EchocardiographyAssociation of Postprocedural Left Atrial Volume and Reservoir Function with Outcomes in Patients with Atrial Fibrillation Undergoing Catheter Ablation
2022, Journal of the American Society of EchocardiographyIs the Atrial Reverse Remodeling after Ablation of Atrial Fibrillation Associated with Reduced Rehospitalization Rate?
2022, Journal of the American Society of Echocardiography
Conflicts of interest: A.B. was supported through the Australian Government Research Training Program Scholarship. A.B. and T.C.T. report unrelated institutional grants for performing research in the field of atrial fibrillation from Bayer Healthcare. All other authors report no competing interests.