Key result
In patients with atrial fibrillation, a high FIB-4 index (>2.67) was associated with an increased risk of all-cause death compared to a low FIB-4 index (aHR 1.357; 95% CI 1.183-1.555; p<0.001).
Why the study?
Atrial fibrillation increases the risk of tricuspid regurgitation, but whether the Fibrosis-4 index correlates with tricuspid regurgitation severity and prognosis in this population remained unclear.
Does a high FIB-4 index predict increased all-cause mortality and reflect tricuspid regurgitation severity in patients with atrial fibrillation?
Cohort (n=4,919)
No
Does a high FIB-4 index predict increased all-cause mortality and reflect tricuspid regurgitation severity in patients with atrial fibrillation?
Hazard Ratio: 1.357 (95% CI 1.183–1.555)
p-value: p=< 0.001
In patients with atrial fibrillation, a high FIB-4 index is associated with greater tricuspid regurgitation severity and increased all-cause mortality, suggesting its utility as a non-invasive prognostic marker.
FIB-4 may aid TR risk stratification in AF; leaves open incremental value and requires prospective validation.
AIMS: Atrial fibrillation is a prevalent disease with increased risk of tricuspid regurgitation (TR), which can worsen prognosis by causing right heart remodelling. Fibrosis-4 index (FIB-4), a composite marker originally developed for liver fibrosis, has been revealed of prognostic value in heart failure. We aimed to clarify the association between FIB-4 and the severity of TR as well as the prognosis. METHODS AND RESULTS: We conducted a retrospective cohort study in a medical centre, identifying atrial fibrillation patients with complete biochemical and echocardiographic data for evaluation. Up to 4919 patients were included. The median age was 75 years, 60.0% (n = 2952) of patients were male, 40.8% (n = 2008) of patients had significant mitral regurgitation, 52.1% (n = 2564) of patients had significant TR, and 34.4% (n = 1691) had both. The median level of FIB-4 was 2.33. Using multivariable regression, a positive correlation was observed between significant TR and FIB-4. With a median follow-up duration of 3.9 years, mortality occurred in 2694 (54.8%) patients. The high FIB-4 group (>2.67) was associated with an increased risk of all-cause death (adjusted hazard ratio [aHR] 1.357, 95% confidence interval [CI] 1.183-1.555, p < 0.001) when compared with the low FIB-4 group (<1.3). In subgroup of isolated TR, high FIB-4 was also associated with significantly higher risks of all-cause mortality (aHR 1.930, 95% CI 1.330-2.801). CONCLUSIONS: In patients with atrial fibrillation, FIB-4 was positively associated with TR severity and an increased risk of all-cause mortality. FIB-4 serves as a simple, non-invasive tool for prognostic stratification of TR and possible surrogate marker for timely intervention.
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Chang et al. (2025) conducted a cohort in Atrial fibrillation (n=4,919). High FIB-4 index (>2.67) vs. Low FIB-4 index (<1.3) was evaluated on all-cause death (aHR 1.357, 95% CI 1.183-1.555, p=< 0.001). In patients with atrial fibrillation, a high FIB-4 index (>2.67) was associated with an increased risk of all-cause death compared to a low FIB-4 index (aHR 1.357; 95% CI 1.183-1.555; p<0.001).
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