Abstract 12840: Left Atrial Enlargement is a Useful Predictor for Incident Heart Failure in Atrial Fibrillation Patients Without Pre-Existing Heart Failure

Abstract

Background: Atrial fibrillation (AF) increases the risk of heart failure (HF). However, little focus has been placed on the risk stratification for HF in AF patients. Hypothesis: Left atrial diameter (LAD) is a simple prognostic parameter in patients with HF. We hypothesized that LAD is a useful predictor for incident HF in AF patients even without pre-existing HF. Methods: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Japan. After excluding patients with pre-existing HF (defined as having one of the following; prior HF hospitalization, New York Heart Association class ≥2, or left ventricular ejection fraction <40%), we investigated 2,464 patients with the data of LAD at enrollment. We divided the patients into 4 groups stratified by LAD (<40 mm, 40-44 mm, 45-49 mm, and ≥50 mm), and compared the backgrounds and incidence of HF hospitalization between the groups. Results: Of 2,464 patients (mean age: 72±11 years, female: 919 [37%], paroxysmal AF: 1,405 [57%], and mean CHA2DS2-VASc score: 3.0±1.6), the mean LAD was 42±8 mm (<40 mm: 1007 [41%], 40-44 mm: 650 [26%], 45-49 mm: 467 [19%] and ≥50 mm: 340 [14%], respectively). Patients with larger LAD had a higher prevalence of elderly and non-paroxysmal AF, and had a higher CHA2DS2-VASc score (all P<0.001). During the median follow-up of 6.0 years, 260 patients (11%) were hospitalized for HF (annual incidence: 1.8% per person-year). Kaplan-Meier curves revealed that LAD was able to stratify the incidence of HF hospitalization in AF patients without HF (Figure). Multivariable Cox regression analysis demonstrated that larger LAD were independently associated with the risk of HF after adjustment by age, sex, AF type, and CHA2DS2-VASc score (Figure). Conclusion: Larger LAD was significantly associated with the higher incidence of HF hospitalization in AF without pre-existing HF, suggesting the utility of LAD regarding the risk stratification for HF in these patients.