Association of the EHRA/HRS/APHRS/LHRS definition of atrial cardiomyopathy with incident atrial fibrillation, heart failure, and stroke

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: High risk for incident atrial fibrillation (n=211). Intervention: Atrial cardiomyopathy (EHRA/HRS/APHRS/LHRS 2024 definition) vs. No atrial cardiomyopathy. Primary outcome: Composite of incident atrial fibrillation, heart failure, or stroke (aHR 9.3, 95% CI 1.2-70.4, p=0.03).

Khalid Kazi; Ali Wahab; Catherine Revnolds; Gregory Y.H. Lip; Jianhua Wu; Andreas Goette; Chris P Gale; Ramesh Nadarajah

doi:10.1093/europace/euag259

September 1, 2026EP EuropaceOpen Access

Association of the EHRA/HRS/APHRS/LHRS definition of atrial cardiomyopathy with incident atrial fibrillation, heart failure, and stroke

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Key result

Atrial cardiomyopathy is linked to a ~9-fold higher risk of AF, HF, or stroke.

aHR 9.3
95% CI 1.2-70.4
P=0.03
n=211

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Why the study?

Does the presence of atrial cardiomyopathy (EHRA/HRS/APHRS/LHRS definition) predict incident atrial fibrillation, heart failure, and stroke in high-risk patients without prior cardiovascular events?

Key Points

To evaluate whether the 2024 EHRA/HRS/APHRS/LHRS consensus definition of atrial cardiomyopathy predicts incident atrial fibrillation, heart failure, and stroke.
In a prospective longitudinal cohort of 211 older participants (median age 75.0 years, 51.7% women) at high risk for atrial fibrillation without baseline atrial fibrillation, heart failure, or stroke, atrial cardiomyopathy was defined across geometry (indexed left atrial volume ≥34 mL/m2), electrophysiology (PR interval ≥200 ms), and biomarker (NT-proBNP >365 pg/mL) domains.
Participants were categorized into Stages 1 to 3 based on the number of domains met and followed through electronic health records over a median of 24.5 months for a composite primary outcome of incident atrial fibrillation, heart failure, or stroke.
The primary composite outcome occurred in 16/130 participants with atrial cardiomyopathy (6.5 events per 100 person-years) versus 1/81 participants without atrial cardiomyopathy (0.6 events per 100 person-years; aHR 9.3, 95% CI 1.2–70.4, P = 0.03).
Risk increased with advancing stage: compared to no atrial cardiomyopathy, the aHR was 4.9 (95% CI 0.6–41.0, P = 0.14) for Stage 1, 22.1 (95% CI 2.6–187.1, P < 0.01) for Stage 2, and 45.7 (95% CI 4.6–456.4, P < 0.01) for Stage 3, increasing by 3.5 times per stage (95% CI 2.0–6.0, P < 0.01).
All incident atrial fibrillation (n = 6) and ischaemic stroke (n = 3) events occurred exclusively in participants with atrial cardiomyopathy.

Study Design

Type

Cohort (n=211)

Structured PICO

Does the presence of atrial cardiomyopathy (EHRA/HRS/APHRS/LHRS definition) predict incident atrial fibrillation, heart failure, and stroke in high-risk patients without prior cardiovascular events?

P

Population

211 older adults (median age 75) at high risk for incident atrial fibrillation but without prior AF, HF, or stroke, followed for a median of 24.5 months.

E

Exposure

Presence of Atrial Cardiomyopathy (AtCM) defined by the EHRA/HRS/APHRS/LHRS 2024 criteria (indexed left atrial volume ≥34 mL/m², PR interval ≥200 ms, and/or NT-proBNP >365 pg/mL)

C

Comparator

Absence of Atrial Cardiomyopathy (AtCM)

O

Outcome

Composite of incident atrial fibrillation, heart failure, or stroke assessed via routine electronic health recordscomposite

Main Result

Hazard Ratio: 9.3 (95% CI 1.2–70.4)

Absolute Event Rate: 12.3% vs 1.2%

p-value: p=0.03

Limitations

Cohort from a single country
Small number of incident events producing wide CIs and precluding component-specific modelling
Could not compare to the Heart Failure Association of the European Society of Cardiology definition due to lack of left atrial reservoir strain
Lack of continuous rhythm monitoring to assess AF burden
Cohort from a single country, limiting international generalizability
Small number of incident events precluded component-specific modelling and produced wide CIs
Could not compare to the HFA-ESC definition because the study did not include left atrial reservoir strain

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Implication

The EHRA/HRS/APHRS/LHRS 2024 consensus definition of atrial cardiomyopathy strongly predicts incident atrial fibrillation, heart failure, and stroke in high-risk older adults, particularly at Stage 2 severity or greater.

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Cite This Study

Kazi et al. (2026) conducted a cohort in High risk for incident atrial fibrillation (n=211). Atrial cardiomyopathy (EHRA/HRS/APHRS/LHRS 2024 definition) vs. No atrial cardiomyopathy was evaluated on Composite of incident atrial fibrillation, heart failure, or stroke (aHR 9.3, 95% CI 1.2-70.4, p=0.03). Atrial cardiomyopathy was associated with a significantly increased risk of incident atrial fibrillation, heart failure, or stroke compared to those without atrial cardiomyopathy (aHR 9.3).

synapsesocial.com/papers/6ac1bb3e2ee2d5767be98ee6 https://doi.org/10.1093/europace/euag259

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Association of the EHRA/HRS/APHRS/LHRS definition of atrial cardiomyopathy with incident atrial fibrillation, heart failure, and stroke

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association of the EHRA/HRS/APHRS/LHRS definition of atrial cardiomyopathy with incident atrial fibrillation, heart failure, and stroke

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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