Association between left atrial mechanics parameters and long-term heart failure hospitalizations in a cohort of patients with atrial fibrillation

Abstract Introduction Atrial fibrillation (AF) is the most prevalent sustained arrhythmia and has a strong association with heart failure (HF). Purpose The aim of this study was to analyze the association between left atrial (LA) function echocardiographic parameters and the development of HF during long-term follow-up in patients with AF. Methods Retrospective analysis of a prospective cohort of patients with permanent AF recruited in a tertiary care centre. Conventional bi-dimensional (2D) LA parameters, and LA mechanics by means of 3D wall motion tracking (3DWMT) were collected, and the association with HF hospitalizations at 10-year follow-up was assessed by means of Cox regression analyses. Results 102 patients were included; 52.9% were women, mean age was 78.6 ± 9.8 years. The mean CHAD2DS2-VASc was 4.4 ±1.7 points. At 10-year follow-up, 48 patients (47%) have had a HF hospitalization. The association between clinical and echocardiographic features and outcomes is shown in Table 1. The only clinical variable significantly associated with HF episodes was CHAD2DS2-VASc. Regarding echocardiographic parameters, variables significantly associated with HF admissions during follow up include LVEF, LV mass, and right ventricle-pulmonary artery coupling. In addition, patients with HF hospitalizations had larger atria, worse LA emptying fraction and worse longitudinal strain (HR 0.89 p 0.027). In multivariable logistic regression analysis, the only variables significantly associated with HF episodes were LVEF (HR 0.98, 95%CI 0.96-1.00; p=0.05), RV-PA coupling (HR 0.10, 95% CI 0.03-0.58; p=0.011), and LA longitudinal strain (HR 0.96, 95%CI 0.94-0.99; P=0.015). Conclusions Measures of LA function may be useful in assessing the risk of developing HF in AF patients, and therefore should be incorporated into routine echocardiographic evaluation of these patients.Cox regression analysis