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Left atrial deformation analysis in patients with non-ischaemic dilated cardiomyopathy in atrial fibrillation

Eduard Ródenas-Alesina1,2, Jordi Lozano-Torres1,2, Pablo Eduardo Tobías-Castillo1,2

  • 1Department of Cardiology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.

European Heart Journal. Imaging Methods and Practice
|September 3, 2024
PubMed

Insights

Left atrial function analysis using LA filling index (LAFI) can identify patients with non-ischaemic dilated cardiomyopathy and atrial fibrillation at higher risk of major cardiovascular events. Higher LAFI indicates increased risk and correlates with poorer cardiac function.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Echocardiography

Background:

  • Atrial fibrillation (AF) is a frequent comorbidity in non-ischaemic dilated cardiomyopathy (NIDCM).
  • AF significantly impacts left atrial (LA) function, influencing cardiovascular outcomes.
  • Assessing LA function may stratify risk in NIDCM patients with AF.

Purpose of the Study:

  • To evaluate the utility of LA function analysis in identifying patients with NIDCM and AF at elevated risk of major cardiovascular events (MACE).
  • To determine if specific echocardiographic parameters of LA function can predict adverse cardiovascular outcomes in this population.

Main Methods:

  • Retrospective analysis of 153 NIDCM patients with AF who underwent transthoracic echocardiography (TTE).
  • Measurement of peak atrial longitudinal strain (PALS), LA emptying fraction, and LA filling index (LAFI = E wave/PALS).
  • Cox regression analysis to identify independent predictors of MACE, adjusting for clinical and echocardiographic variables.

Main Results:

  • LAFI emerged as the sole independent TTE predictor of MACE after multivariable adjustment (adjusted HR = 1.02 per point increase, P=0.024).
  • A LAFI cutoff of ≥15 significantly predicted MACE (HR=1.95), cardiovascular death (HR=3.68), heart failure admission (HR=2.13), and ventricular arrhythmia (HR=4.72).
  • Higher LAFI correlated with worsening left ventricular global longitudinal strain (LV-GLS), elevated pulmonary pressures, and impaired right ventricular function.

Conclusions:

  • LA deformation analysis, specifically LAFI, is feasible and clinically relevant in NIDCM patients with AF.
  • LAFI serves as a valuable tool for risk stratification, identifying patients prone to MACE.
  • Elevated LAFI suggests increased left-sided ventricular pressures and poorer right ventricular performance in this cohort.
Abstract

Keywords:
atrial fibrillationechocardiographyleft atrial filling indexleft atrial strainnon-ischaemic dilated cardiomyopathy

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