Key result
AF in dilated cardiomyopathy is linked to ~1.7-point worse LVGLS compared to sinus rhythm.
Why the study?
Atrial fibrillation is common in DCM and impacts cardiac function with clinical consequences, but its impact across all heart chambers using advanced echocardiography required assessment.
Does persistent or permanent atrial fibrillation impair cardiac chamber remodeling and function in patients with dilated cardiomyopathy compared to sinus rhythm?
Observational (n=88)
No
Does persistent or permanent atrial fibrillation impair cardiac chamber remodeling and function in patients with dilated cardiomyopathy compared to sinus rhythm?
Absolute Event Rate: 6.2% vs 7.9%
p-value: p=0.008
Atrial fibrillation independently worsens bi-atrial and ventricular remodeling and function in patients with dilated cardiomyopathy, highlighting the potential importance of maintaining sinus rhythm.
AF associated with worse GLS and biventricular remodeling in DCM; leaves open whether rhythm control mitigates effects.
Atrial fibrillation is frequently seen in patients with dilated cardiomyopathy (DCM), and its presence impacts the function of the heart, with clinical and prognostic consequences. In this prospective single-center study, we aimed to assess the impact of atrial fibrillation on cardiac structure and function, using comprehensive two- and three-dimensional echocardiography. We included 41 patients with DCM and persistent or permanent atrial fibrillation (38 male, age 58.8 ± 11 years), as well as 47 patients with DCM and in sinus rhythm (35 male, age 58 ± 12.5 years). Cardiac chambers and mitral and tricuspid valves' structure and function were assessed via standard two-dimensional, speckle-tracking, and three-dimensional echocardiography (3DE). Patients with DCM and atrial fibrillation had a more impaired left ventricular global longitudinal strain, higher 3DE left atrial volumes, and reduced function compared to patients in sinus rhythm in the presence of similar left ventricle volumes. Mitral annulus configuration was altered in atrial fibrillation DCM patients. Also, right heart volumes were larger, with more severe atrial and ventricular dysfunction, despite similar estimated pulmonary artery pressures and severity of tricuspid regurgitation. Using advanced echocardiography techniques, we demonstrated that atrial fibrillation induces significant remodeling in all heart chambers.
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Iovănescu et al. (2023) conducted an observational in Dilated cardiomyopathy (n=88). Persistent or permanent atrial fibrillation vs. Sinus rhythm was evaluated on Left ventricular global longitudinal strain (LVGLS) as an absolute value (p=0.008). In patients with dilated cardiomyopathy, the presence of atrial fibrillation was associated with a significantly more impaired left ventricular global longitudinal strain (6.2% vs 7.9%, p=0.008) alongside increased left and right heart remodeling compared to sinus rhythm.
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