A CMR-derived PCWP ≥16 mmHg was associated with a hazard ratio of 2.88 for future atrial fibrillation in older adults during a 4-year follow-up study.
Does non-invasive CMR-derived PCWP predict incident atrial fibrillation in older, high-stroke-risk individuals?
Non-invasive CMR-derived PCWP ≥16 mmHg is a strong independent predictor of incident atrial fibrillation in older, high-risk individuals.
Absolute Event Rate: 0% vs 0%
Abstract Background Elevated pulmonary capillary wedge pressure (PCWP) is known to drive atrial fibrillation (AF). However, it remains unknown if non-invasive Cardiovascular Magnetic Resonance (CMR) - derived PCWP could predict the future risk of AF. This study investigated whether a CMR-derived measure of PCWP could predict future AF. Methods We enrolled 202 participants (mean age 76.2±4.2 years) from the LOOP study, each receiving implantable loop recorder (ILR) for continuous rhythm monitoring over 4 years. CMR imaging quantified left atrial volume (LAV) and left ventricular mass (LVM), allowing calculation of a validated sex-specific equation derived PCWP. Cox proportional hazards analysis identified independent variables associated with incident AF. Results Eighty-six participants (42.6%) manifested AF during follow-up. Individuals with AF exhibited significantly higher CMR-PCWP (16.1±2.8 vs. 14.7±2.3 mmHg, p0.01) and greater LAV. Univariate regression highlighted that PCWP ≥16 mmHg was significantly associated with incident AF (hazard ratio 2.73). Stepwise Cox regression confirmed that PCWP ≥16 mmHg and the CHARGE-AF score remained independently associated with AF, with PCWP conveying higher hazard ratio (2.88, p0.001). Kaplan-Meier analysis reinforced the importance of this threshold for AF onset, demonstrating a significantly increased probability of arrhythmia over time and emphasising its decisive clinical impact. Conclusion Elevated CMR-PCWP is associated with AF in older, high-stroke-risk individuals, underscoring the role of subclinical diastolic dysfunction in promoting arrhythmogenesis. Incorporating non-invasive PCWP assessment into routine CMR evaluation may enhance risk stratification, allowing prompt identification of at-risk patients and enabling earlier, precise, targeted measures for AF prevention.
Kalaitzoglou et al. (Tue,) reported a other. A CMR-derived PCWP ≥16 mmHg was associated with a hazard ratio of 2.88 for future atrial fibrillation in older adults during a 4-year follow-up study.