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Updated: Jul 11, 2025

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Prediction of incident atrial fibrillation in hypertrophic cardiomyopathy

Maria Angela Losi1, Emanuele Monda2, Raffaella Lombardi1

  • 1Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.

International Journal of Cardiology
|November 11, 2023
PubMed

Insights

Left atrial diameter is a simple echocardiographic measure that can predict atrial fibrillation (AF) development in hypertrophic cardiomyopathy (HCM) patients. This measurement is more effective than the HCM-AF Score for identifying individuals at high risk for AF.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Medical Imaging

Background:

  • Atrial fibrillation (AF) is a common arrhythmia in hypertrophic cardiomyopathy (HCM) with significant prognostic implications.
  • Predicting AF development in HCM patients is crucial for timely intervention and improved outcomes.

Purpose of the Study:

  • To compare the predictive value of left atrial (LA) diameter measurement against the HCM-AF Score for AF development in HCM patients.
  • To identify simple and effective methods for risk stratification of AF in HCM.

Main Methods:

  • A cohort of 519 HCM patients without a history of AF was followed prospectively.
  • The primary endpoint was the documented development of AF via ECG.
  • Left atrial diameter and HCM-AF score were assessed and compared for their predictive accuracy using ROC curve analysis.

Main Results:

  • During a mean follow-up of 8 years, 19% of patients developed AF.
  • Patients who developed AF had larger LA diameters, greater LV wall thickness, and higher LV outflow tract obstruction.
  • Left atrial diameter demonstrated a significantly greater area under the ROC curve compared to the HCM-AF Score (p < 0.0001).

Conclusions:

  • Left atrial diameter is a powerful, standalone predictor of AF development in HCM.
  • A LA diameter > 46 mm at 5-year follow-up accurately predicts AF development, similar to an HCM-AF score >= 22.
  • This simple echocardiographic measure offers a valuable tool for risk-stratifying HCM patients for AF.
Abstract

Keywords:
Atrial fibrillationHypertrophic cardiomyopathyScore

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