Left atrial stiffness index predicts atrial fibrillation risk in heart failure with preserved ejection fraction: a...

Develop a LASI-based nomogram for predicting atrial fibrillation (AF) risk in heart failure with preserved ejection fraction (HFpEF).

This retrospective study analyzed 275 HFpEF patients (160 AF, 115 controls). Echocardiography measured LASI (E/e' divided by peak atrial longitudinal strain), left atrial volumes, strains (AP2%, AP4%), and electromechanical delays (SD2: inter-atrial; SD4: intra-left atrial). Multivariate logistic regression identified AF predictors. Nomogram performance was validated by ROC analysis and DCA.

Compared to controls, the AF group had significantly larger LVDD/LVSD (P<0.001 both), lower 3D-LAEF% (P<0.001), lower E/e' (P<0.001), higher LASI (P<0.001), larger BSA (P<0.001), higher AP2% (P<0.001), lower AP4% (P<0.001), and longer SD4 (P<0.001). Multivariate analysis identified positive associations with AF risk for: BSA (OR=9.167, P<0.001), AP4% (OR=1.033, P=0.008), SD2 (OR=1.003, P=0.001), and LASI (OR=1.043, P<0.001). Negative associations were found for E/e' (OR=0.889, P=0.002) and SD4 (OR=0.997, P<0.001). ROC AUCs were: LASI=0.666, E/e'=0.707, BSA=0.682, SD2=0.615, AP4=0.666, SD4=0.705. The combined model AUC was 0.801. DCA identified LASI as the optimal single predictor (net benefit 0.3184).

LASI independently predicted AF risk in HFpEF. The validated nomogram, integrating LASI, BSA, and electromechanical markers (SD2, SD4, AP4%, E/e'), enables precise AF risk stratification, aiding early identification of high-risk patients for targeted intervention.