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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Prognostic Implications of the 2025 American Society of Echocardiography Guidelines for the Evaluation of Left
Katsuomi Iwakura1, Shiro Hoshida2, Nobuaki Tanaka1
1Division of Cardiology, Sakurabashi Watanabe Advanced Healthcare Hospital, Osaka, Japan.
Background:
Noninvasive assessment of left atrial pressure (LAP) remains difficult in patients with atrial fibrillation (AF). The American Society of Echocardiography updated the Recommendations for the Evaluation of Left Ventricular Diastolic Function and introduced a specific algorithm for LAP estimation in AF. We retrospectively investigated the prognostic value of the new algorithm-based LAP assessment in patients with heart failure with preserved ejection fraction (HFpEF) and persistent AF.
Methods:
This study included 363 patients hospitalized for acutely decompensated HFpEF who had persistent AF at discharge. LAP was categorized as normal, elevated, or indeterminate at discharge using echocardiography, according to the algorithm outlined in the 2025 guidelines of the American Society of Echocardiography. Multivariable Cox proportional hazards models were constructed to assess associations between LAP classification and clinical outcomes, including death, heart failure (HF) hospitalization, and stroke, during a follow-up of 574 days.
Results:
LAP was classified as elevated in 93 patients (25.6%) and as normal in 165 (45.5%), while it was indeterminate in 105 (28.9%) cases because of missing variables recommended in the 2025 guidelines. Elevated LAP was independently associated with HF hospitalization during the follow-up period (hazard ratio, 1.57; 95% CI, 1.05-2.37; P = .03), whereas it was not identified as an independent predictor of death or stroke after adjustment. This association remained significant after accounting for the competing risk of death and was largely preserved across multiple imputation and sensitivity analyses that used different assumptions for indeterminate cases. The incremental value of LAP estimation for predicting HF hospitalization over natriuretic peptides was modest and did not reach statistical significance.
Conclusions:
In patients hospitalized for HFpEF with persistent AF, LAP classification was associated with HF hospitalization, implying the clinical relevance of the 2025 algorithm-based approach in this challenging population.
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