Left ventricular dysfunction in atrial fibrillation and heart failure risk

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Imaging

Background:

• Atrial fibrillation (AF) is associated with adverse cardiac remodeling and dysfunction.
• Conventional echocardiographic parameters may not fully capture subtle left ventricular (LV) functional impairments in AF.
• Novel myocardial deformation analysis offers a more sensitive assessment of LV function.

Purpose of the Study:

• To investigate the functional correlates, clinical relevance, and prognostic implications of LV deformations in patients with AF.
• To assess the added value of LV deformation indices over conventional measures for risk stratification in AF.

Main Methods:

• A large-scale cohort of 1483 newly diagnosed AF patients underwent echocardiographic assessment.
• LV deformational indices, including global longitudinal strain (GLS), systolic strain rates (SRs), and early diastolic strain rates (SRe), were measured using a three-beat method.
• Correlations with clinical markers (C-reactive protein, NT-proBNP), conventional echocardiographic parameters (LVEF, E/e'), and clinical outcomes (HF re-admissions/death) were analyzed.

Main Results:

• Worsened GLS, SRs, and SRe were independently correlated with higher C-reactive protein, NT-proBNP, E/e', lower eGFR, permanent AF, and prevalent heart failure (HF).
• Abnormal GLS was prevalent (67.8%) despite preserved average LVEF (58.4%).
• Worse GLS and SRe were associated with increased HF re-admissions/death, offering improved risk reclassification when added to LVEF, LV mass index, and E/e'.

Conclusions:

• Impaired LV function, assessed by myocardial deformation, is common in AF patients and provides independent prognostic information.
• Cardiac deformation analysis offers superior risk prediction compared to conventional echocardiographic measures in AF.
• Implementing cardiac deformation analysis in clinical practice for AF patients is recommended.