Key result
Mechanical atrial dysfunction independently predicted adverse outcomes in HFpEF (HR per 1% decrease 1.049; 95% CI 1.014-1.085; P=0.006), mediating the adverse effect of atrial fibrillation.
Why the study?
The prognostic implications of mechanical atrial dysfunction in HFpEF patients across different stages of AF were not well characterized.
Does mechanical atrial dysfunction predict adverse outcomes independently of atrial fibrillation status in patients with HFpEF?
Cohort (n=258)
Does mechanical atrial dysfunction predict adverse outcomes independently of atrial fibrillation status in patients with HFpEF?
Hazard Ratio: 1.049 (95% CI 1.014–1.085)
p-value: p=0.006
Mechanical atrial dysfunction, measured by left atrial reservoir strain, is a stronger independent predictor of adverse outcomes in HFpEF than atrial fibrillation status alone.
Mechanical atrial dysfunction may aid risk stratification across AF stages in HFpEF; leaves open prospective validation before clinical adoption.
AIMS: This study assessed the prognostic implications of mechanical atrial dysfunction in heart failure with preserved ejection fraction (HFpEF) patients with different stages of atrial fibrillation (AF) in detail. METHODS AND RESULTS: HFpEF patients (n = 258) systemically underwent an extensive clinical characterization, including 24-h Holter monitoring and speckle-tracking echocardiography. Patients were categorized according to rhythm and stages of AF: 112 with no history of AF (no AF), 56 with paroxysmal AF (PAF), and 90 with sustained (persistent/permanent) AF (SAF). A progressive decrease in mechanical atrial function was seen: left atrial reservoir strain (LASr) 30.5 ± 10.5% (no AF), 22.3 ± 10.5% (PAF), and 13.9 ± 7.8% (SAF), P < 0.001. Independent predictors for lower LASr values were AF, absence of chronic obstructive pulmonary disease, higher N-terminal-pro hormone B-type natriuretic peptide, left atrial volume index, and relative wall thickness, lower left ventricular global longitudinal strain, and echocardiographic signs of elevated left ventricular filling pressure. LASr was an independent predictor of adverse outcome (hazard ratio per 1% decrease =1.049, 95% confidence interval 1.014-1.085, P = 0.006), whereas AF was not when the multivariable model included LASr. Moreover, LASr mediated the adverse outcome associated with AF in HFpEF (P = 0.008). CONCLUSION: Mechanical atrial dysfunction has a possible greater prognostic role in HFpEF compared to AF status alone. Mechanical atrial dysfunction is a predictor of adverse outcome independently of AF presence or stage, and may be an underlying mechanism (mediator) for the worse outcome associated with AF in HFpEF. This may suggest mechanical atrial dysfunction plays a crucial role in disease progression in HFpEF patients with AF, and possibly also in HFpEF patients without AF.
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Weerts et al. (2021) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=258). Mechanical atrial dysfunction (left atrial reservoir strain) vs. Higher left atrial reservoir strain was evaluated on Adverse outcome (HR 1.049, 95% CI 1.014-1.085, p=0.006). Mechanical atrial dysfunction independently predicted adverse outcomes in HFpEF (HR per 1% decrease 1.049; 95% CI 1.014-1.085; P=0.006), mediating the adverse effect of atrial fibrillation.
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