Association of HFA-PEFF Score with Left Atrial Mechanics, Pressure, and Reverse Remodeling in Atrial Fibrillation

Diagnosis of heart failure with preserved left ventricular ejection fraction remains a significant clinical challenge, particularly in patients with atrial fibrillation (AF). Recently, the Heart Failure Association Pretest assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology (HFA-PEFF) score was introduced to aid in the diagnostic workup of heart failure with preserved left ventricular ejection fraction. This study aimed to investigate the distribution of the HFA-PEFF score and its relationship with left atrial (LA) function, pressure, and reverse remodeling in patients with AF.

We investigated 155 patients with AF who underwent their first catheter ablation (CA). Echocardiography was performed before CA, and the HFA-PEFF score was calculated. Direct LA pressure (LAP) was measured at CA. Echocardiography was repeated 6 months after CA to evaluate LA reverse remodeling.

High (5-6), intermediate (2-4), and low (0-1) HFA-PEFF scores were observed in 19 (12.3%), 99 (63.9%), and 37 (23.9%) patients, respectively. Higher HFA-PEFF scores were associated with worse LA function and LA stiffness (both P < .05). Elevated LAP was detected in 31.6%, 19.2%, and 5.4% of the high, intermediate, and low HFA-PEFF score groups, respectively. In the intermediate HFA-PEFF score group, LA stiffness was a good predictor of elevated LAP, whereas left ventricular global longitudinal strain was more predictive in the high HFA-PEFF score group. Six months after CA, all groups exhibited LA reverse remodeling, while the high-score group retained a larger LA size and worse LA function.

Higher HFA-PEFF scores were associated with advanced LA functional remodeling and elevated LAP in patients with AF. Persistent LA remodeling after CA in the high-score group demonstrates the need for careful follow-up.