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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Atrial fibrillation pattern, left atrial diameter and risk of cardiovascular events and mortality. A prospective

Danilo Menichelli1, Angela Sciacqua2, Roberto Cangemi3

  • 1I Clinica Medica, Atherothrombosis Centre, Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.

International Journal of Clinical Practice
|October 20, 2020
PubMed

Insights

Left atrial diameter (LAd) predicts cardiovascular events in atrial fibrillation (AF) patients. This simple measurement offers prognostic value regardless of AF pattern, aiding risk stratification for cardiovascular outcomes.

Area of Science:

  • Cardiology
  • Echocardiography
  • Atrial Fibrillation Research

Background:

  • Conflicting evidence exists regarding the association between atrial fibrillation (AF) patterns (persistent/permanent vs. paroxysmal) and ischemic event risk.
  • The role of left atrial diameter (LAd) in modulating cardiovascular outcomes across different AF patterns requires clarification.

Purpose of the Study:

  • To investigate whether left atrial diameter (LAd) influences the risk of cardiovascular outcomes in patients with non-valvular atrial fibrillation.
  • To determine if LAd provides prognostic information independently of AF pattern (paroxysmal AF vs. persistent/permanent AF).

Main Methods:

  • Prospective multicenter observational study including 1,252 non-valvular AF patients.
  • Left atrial anteroposterior diameter (LAd) measured via transthoracic echocardiography.
  • Endpoints included cardiovascular events (CVEs), major adverse cardiac events (MACE), and cardiovascular death over a mean follow-up of 42.2 months.

Main Results:

  • Patients with persistent/permanent AF showed a higher proportion of LAd above the median (≥44 mm) compared to paroxysmal AF (59.5% vs. 37.5%, P < .001).
  • Higher LAd was significantly associated with increased rates of CVEs, MACE, and cardiovascular death (log-rank tests, P < .001 for all).
  • Multivariable analysis confirmed LAd above the median as an independent predictor for CVEs (HR 1.569), MACE (HR 1.858), and CV death (HR 2.106), irrespective of AF pattern.

Conclusions:

  • Left atrial diameter (LAd) is a readily obtainable parameter in AF patients.
  • LAd provides significant prognostic information regarding the risk of cardiovascular events, MACE, and cardiovascular death.
  • The prognostic value of LAd is consistent across both paroxysmal and persistent/permanent atrial fibrillation patterns.
Abstract

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