Atrial fibrillation in patients with left ventricular non-compaction: incidence and associations with stroke, heart failure, and mortality

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Left ventricular non-compaction (LVNC) (n=68695). Intervention: Atrial fibrillation vs. LVNC without atrial fibrillation. Primary outcome: 3-year risk of a composite of all-cause mortality, stroke, acute myocardial infarction, and heart failure (HR 1.301, 95% CI 1.269-1.334).

Amir Askarinejad; T F Luescher; G Y H Lip

doi:10.1093/cvr/cvag156

July 8, 2026Cardiovascular ResearchOpen Access

Atrial fibrillation in patients with left ventricular non-compaction: incidence and associations with stroke, heart failure, and mortality

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Key result

In patients with left ventricular non-compaction, the presence of atrial fibrillation was associated with a higher 3-year risk of a composite of mortality, stroke, myocardial infarction, and heart failure.

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Why the study?

LVNC-related structural and functional abnormalities may increase AF risk, but data on AF incidence and clinical outcomes in LVNC are limited.

Does the presence of atrial fibrillation increase the risk of adverse cardiovascular events and mortality in patients with left ventricular non-compaction?

Key Points

To evaluate the incidence of atrial fibrillation (AF) in patients with left ventricular non-compaction (LVNC) and determine the 3-year risk of major adverse cardiovascular outcomes in patients with versus without AF.
Retrospective cohort analysis using the TriNetX platform comparing LVNC patients with AF (N=29,356) to LVNC patients without AF (N=39,339), all without a history of stroke.
Propensity score matching (PSM) was conducted using a 1:1 greedy nearest-neighbour method with a caliper of 0.1 to balance baseline demographics and comorbidities, yielding 19,615 matched pairs.
Hazard ratios (HRs) and 95% confidence intervals were estimated using univariable Cox proportional hazards models over a 3-year outcome window.
The 1-year incidence of AF among patients with LVNC was 36.1 per 1000 person-years (3.38%).
After PSM, the primary composite outcome of all-cause mortality, stroke, acute myocardial infarction, and heart failure was significantly increased in patients with AF (HR 1.301, 95% CI 1.269–1.334).
After matching, AF was associated with higher 3-year risks of stroke (8.3% vs. 5.8%; HR 1.466, 95% CI 1.359–1.581), new-onset heart failure (32.2% vs. 22.9%; HR 1.439, 95% CI 1.358–1.526), and all-cause death (22.0% vs. 17.8%; HR 1.255, 95% CI 1.200–1.312), but not acute myocardial infarction (8.7% vs. 8.8%; HR 0.985, 95% CI 0.922–1.054).

Study Design

Type

Observational (n=68,695)

Multicenter

Yes

Structured PICO

Does the presence of atrial fibrillation increase the risk of adverse cardiovascular events and mortality in patients with left ventricular non-compaction?

P

Population

68,695 patients with left ventricular non-compaction, with and without atrial fibrillation, identified from a US health research network and followed for 3 years.

E

Exposure

Presence of atrial fibrillation (AF)

C

Comparator

Absence of atrial fibrillation (AF)

O

Outcome

3-year risk of a composite of all-cause mortality, stroke, acute myocardial infarction, and heart failurecomposite

Main Result

Hazard Ratio: 1.301 (95% CI 1.269–1.334)

Limitations

Diagnosis of LVNC was based on ICD-10 coding without imaging confirmation, which may lead to misclassification.
Retrospective, observational design is subject to selection bias and cannot establish causal relationships.
Potential for residual confounding due to unmeasured variables despite propensity score matching.
Residual imbalance in BMI remained after propensity score matching.
Subgroup analyses were exploratory.
No formal imputation of missing data was performed.
Limited generalizability to healthcare settings outside the TriNetX network.
Did not include genotype data, limiting mechanistic inference regarding genetic predisposition

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Implication

In patients with left ventricular non-compaction, the presence of atrial fibrillation is common and independently associated with significantly increased risks of stroke, heart failure, and all-cause mortality.

Abstract

AIMS: Left ventricular non-compaction (LVNC) is a genetic cardiomyopathy with presentations ranging from asymptomatic disease to heart failure, stroke, and sudden cardiac death. LVNC-related structural and functional abnormalities may increase atrial fibrillation (AF) risk, but data are limited. We assessed AF incidence in LVNC and compared outcomes in patients with versus without AF. METHODS AND RESULTS: Two cohorts of patients were identified using the TriNetX platform: (i) patients with LVNC without a prior history of AF or stroke; and (ii) patients with LVNC and AF without a prior history of stroke. The primary objective was to assess the 3-year risk of a composite of all-cause mortality, stroke, acute myocardial infarction, and heart failure in the two cohorts. Hazard ratios (HRs) were derived from univariable cox proportional models before and after propensity score matching (PSM). Matching was conducted using a greedy nearest-neighbour approach with a caliper of 0.1.Patients with LVNC and AF (N=29,356) were older and exhibited a higher burden of comorbidities compared with LVNC patients without AF (N=39,339). In this observational analysis, after PSM, AF in patients with LVNC was associated with higher risks of stroke (HR 1.466, 95% CI 1.359-1.581), new-onset heart failure (HR 1.439, 95% CI 1.358-1.526), all-cause death (HR 1.255, 95% CI 1.200-1.312), and the composite outcome (HR 1.301, 95% CI 1.269-1.334) compared with LVNC patients without AF. The 1-year incidence of AF in patients with LVNC was 36 per 1000 person-years. CONCLUSION: In this observational cohort, LVNC was associated with a high incidence of AF, and the presence of AF was associated with higher risks of stroke, heart failure, and all-cause death. Further prospective studies are warranted to assess the prognostic impact of AF in patients with LVNC.

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Cite This Study

Askarinejad et al. (2026) conducted an observational in Left ventricular non-compaction (LVNC) (n=68,695). Atrial fibrillation vs. LVNC without atrial fibrillation was evaluated on 3-year risk of a composite of all-cause mortality, stroke, acute myocardial infarction, and heart failure (HR 1.301, 95% CI 1.269-1.334). In patients with left ventricular non-compaction, the presence of atrial fibrillation was associated with a higher 3-year risk of a composite of mortality, stroke, myocardial infarction, and heart failure.

synapsesocial.com/papers/6a51de38c18d7f28ca50046a https://doi.org/10.1093/cvr/cvag156

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Atrial fibrillation in patients with left ventricular non-compaction: incidence and associations with stroke, heart failure, and mortality

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Atrial fibrillation in patients with left ventricular non-compaction: incidence and associations with stroke, heart failure, and mortality

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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