Left ventricular geometry and outcomes in patients with atrial fibrillation: the AFFIRM Trial

Area of Science:

• Cardiology
• Echocardiography
• Clinical Outcomes

Background:

• Left ventricular hypertrophy (LVH) is a significant cardiovascular disease marker.
• LVH is associated with prognosis and clinical outcomes in various conditions.
• The prognostic value of LVH in atrial fibrillation (AF) patients requires further investigation.

Purpose of the Study:

• To determine if echocardiographically determined LVH predicts outcomes in patients with AF.
• To assess the association between LVH and mortality and stroke in AF.
• To explore specific LVH remodeling patterns and their impact on AF patient outcomes.

Main Methods:

• Post-hoc analysis of patients with echocardiographic data from the AFFIRM Trial.
• Stratification based on gender-adjusted interventricular septal (IVS) thickness, relative wall thickness (RWT), and LV mass.
• Classification of LV remodeling types: normal geometry, concentric hypertrophy, eccentric hypertrophy, and concentric remodeling.

Main Results:

• LVH, defined by abnormal IVS thickness, independently predicted all-cause mortality (HR 1.46) and stroke (HR 1.89) in AF patients.
• These associations were consistent whether IVS thickness was continuous or categorical.
• Concentric LV hypertrophy showed the highest association with all-cause mortality (HR 1.53).

Conclusions:

• Echocardiographic IVS thickness is a valuable tool for risk stratification in AF patients.
• LVH may serve as an important prognostic indicator in atrial fibrillation.
• Regression of LVH could be a potential therapeutic goal for improving AF patient outcomes.