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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Left and right atrial echocardiographic parameters and outcomes in patients with atrial fibrillation
Marta Mantovani1,2, Gerardo De Mitri1, Jacopo F Imberti1,2
1Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
Insights
Left atrial volume index (LAVi) and antero-posterior diameter index (iLAAPD) improve risk prediction for adverse outcomes in atrial fibrillation (AF) patients. These echocardiographic parameters enhance discrimination for events like death or heart failure hospitalization.
Area of Science:
- Cardiology
- Echocardiography
- Atrial Fibrillation Research
Background:
- Atrial fibrillation (AF) patients face significant risks of adverse cardiovascular events.
- Left atrial (LA) and right atrial (RA) parameters are potential predictors of these events.
- Evaluating these parameters can improve risk stratification in AF management.
Purpose of the Study:
- To assess the association between LA and RA echocardiographic parameters and a composite endpoint (CEP) in AF patients.
- To determine if specific atrial parameters improve risk prediction beyond established scores.
- To identify key echocardiographic markers for adverse outcomes in atrial fibrillation.
Main Methods:
- Prospective enrollment of 489 AF patients.
- Baseline echocardiography to measure LA/RA diameter index (iLAAPD, iRAAPD), volume index (LAVi, RAVi), sphericity index (LASI, RASI), and emptying fraction.
- Follow-up for a composite endpoint of death, thromboembolism, ACS, and HF hospitalization.
Main Results:
- 129 patients (26.3%) reached the CEP after median follow-up of 1114 days.
- LA emptying fraction <28% and iRAAPD >24 mm/m2 showed highest sensitivity for CEP.
- Left atrial parameters (iLAAPD, LAVi) significantly improved risk reclassification (NRI 0.30-0.32) and predicted adverse outcomes.
- Right atrial parameters were not associated with CEP.
Conclusions:
- Left atrial volume index (LAVi) and LA antero-posterior diameter index (iLAAPD) enhance discrimination and risk prediction for adverse outcomes in AF patients.
- These echocardiographic measures offer valuable prognostic information beyond traditional risk factors.
- Further research may integrate these parameters into clinical risk assessment tools for AF management.
Background:
This study evaluates the association between left atrial and right atrial (LA, RA) parameters and a composite endpoint (CEP) of all-cause death, thromboembolism, acute coronary syndrome, and heart failure hospitalization in atrial fibrillation (AF) patients.
Material And Methods:
Patients were prospectively enrolled. At baseline, the following echocardiogram parameters were measured: LA and RA antero-posterior diameter index (iLAAPD, iRAAPD), LA and RA volume index (LAVi, RAVi), LA and RA sphericity index (LASI, RASI), LA and RA emptying fraction.
Results:
A total of 489 patients (61.3% males) with a median age of 75 (66-80) years and a median CHA2DS2VASc score of 3 (2-5) were enrolled (92.2% receiving anticoagulation). Permanent AF was present in 40.5% of the total cohort. After a median follow-up of 1114 (392-1384) days, 129 patients (26.3%) reached the CEP. The highest sensitivity for CEP was for LA emptying fraction <28% and iRAAPD >24 mm/m2 (72% and 73%, respectively) while the best negative predictive values were for iLAAPD and LAVi (both 81%). Right atrial parameters were not associated with CEP. Discrimination analysis using net reclassification improvement (NRI) showed that iLAAPD and LAVi significantly improved patient reclassification compared to a null model without atrial parameters (iLAAPD NRI 0.30; P = 0.005; LAVi NRI 0.32; P = 0.002). Multivariate Cox regression analysis found that LA dimensions, volume, and function were associated with a higher risk of adverse outcomes and significantly improved risk prediction for the CEP.
Conclusions:
LAVi and iLAAPD enhance discrimination and risk prediction for adverse outcomes in AF patients.
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