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Atrial fibrillation in dilated cardiomyopathy: Outcome prediction from an observational registry

Vincenzo Nuzzi1, Antonio Cannatà1, Paolo Manca1

  • 1Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy.

International Journal of Cardiology
|August 28, 2020
PubMed

Insights

Permanent atrial fibrillation (AF) in dilated cardiomyopathy (DCM) patients, though uncommon, significantly worsens prognosis. This study highlights permanent AF as an independent predictor of adverse outcomes in DCM, emphasizing its clinical importance.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Research

Background:

  • Dilated cardiomyopathy (DCM) is a complex heart condition with significant morbidity and mortality.
  • The specific impact of different atrial fibrillation (AF) subtypes on DCM progression and outcomes remains incompletely understood.
  • Investigating the role of AF in DCM is crucial for improving patient management and long-term prognosis.

Purpose of the Study:

  • To determine the epidemiological and prognostic significance of various atrial fibrillation (AF) types in patients with dilated cardiomyopathy (DCM).
  • To assess the long-term impact of permanent AF (permAF) versus paroxysmal/persistent AF on hard clinical outcomes in DCM.
  • To identify permAF as a potential independent predictor of adverse events in a DCM cohort.

Main Methods:

  • Evaluation of consecutive DCM patients from the Trieste Muscle Heart Disease Registry.
  • Utilized uni- and multivariable analyses, extended Kaplan-Meier survival estimates, and propensity score-matching.
  • Composite outcome included all-cause death, heart transplantation, or ventricular-assist device implantation.

Main Results:

  • Out of 1181 DCM patients, 3.9% had baseline permanent AF (permAF) and 5.6% had a history of paroxysmal/persistent AF.
  • Permanent AF patients were older, had higher NYHA class, and larger left atrial diameter compared to sinus rhythm (SR) patients.
  • Multivariable analysis identified permAF as an independent predictor of adverse outcomes (HR 2.45; p < 0.001); paroxysmal/persistent AF showed neutral prognostic value.

Conclusions:

  • Permanent AF has a low prevalence and incidence in DCM but carries significant prognostic implications.
  • Permanent AF is a strong, independent predictor of hard clinical outcomes in patients with dilated cardiomyopathy.
  • These findings underscore the importance of monitoring and managing AF in DCM patients to mitigate risks.
Abstract

Keywords:
Chronic heart failureDilated cardiomyopathyLong-term outcomePermanent atrial fibrillation

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