Prognostic Value of New Proposed Criteria for Atrial Cardiomyopathy in Patients With Heart Failure

BACKGROUND: Atrial function plays a crucial role in patients with heart failure (HF). Recently, criteria for atrial cardiomyopathy (AtCM) have been proposed based on both electrical and mechanical atrial dysfunction. However, it is unclear whether AtCM defined by the proposed criteria can stratify the risk of adverse events in patients with HF. OBJECTIVES: The authors sought to investigate the association between AtCM and clinical outcomes. METHODS: Between January 2020 and June 2025, 2,046 symptomatic patients with chronic HF from a multicenter registry were prospectively enrolled. Patients who exhibited baseline electrical and mechanical atrial dysfunction on electrocardiography and echocardiography were diagnosed with AtCM. The primary outcome was a composite of all-cause death and hospitalization for worsening HF. RESULTS: During a median follow-up period of 727 days (IQR: 518-1,119), the primary outcome occurred in 427 patients. The incidence of the primary outcome was higher in patients with AtCM than in those without AtCM (P < 0.001). Multivariable regression analyses showed that the presence of AtCM was associated with a higher risk of the primary outcome after adjustment for prognostic covariates, including atrial fibrillation (HR: 1.31; 95% CI: 1.00-1.70). The coexistence of electrical and mechanical atrial dysfunction showed the highest risk of adverse events. CONCLUSIONS: AtCM defined by the proposed criteria identified patients with HF at increased risk of adverse events. Combined electrical and mechanical atrial dysfunction characterized a subgroup with markedly elevated risk, underscoring the clinical relevance of integrating both domains when diagnosing AtCM. (Development of a flail evaluation application based on deep learning; UMIN000043390).