Atrial fibrillation concerning worse prognosis in patients with left ventricular noncompaction

Abstract

Abstract Purpose This study aims to investigate the relationship between atrial fibrillation (AF) and the prognosis of patients with left ventricular noncompaction (LVNC). Methods This retrospective study enrolled 302 patients (median age 46 years, 65.9% male) diagnosed as LVNC through echocardiography or cardiac nuclear magnetic according to Jenni criteria1 and Petersen criteria2, respectively. The primary endpoint is major cardiovascular adverse events (MACEs) which is a composite endpoint including heart transplantation, deaths in-hospital, stroke, system embolism, malignant ventricular arrhythmia, and rehospitalization for cardiovascular reasons. The second endpoints are thromboembolism events including system embolism and stroke. Results The patients with LVNC were divided into 2 groups: with AF group (n=56) and without AF group (n=246). In the group of patients combined with AF and LVNC, the proportion of CHA2DS2-VASc score≥2 was 66.07%. The rate of receiving oral anticoagulant therapy in LVNC patients with AF was significantly higher than without the AF group (69.64% vs. 19.51%, p<0.01). After a median follow-up of 4.3 years, a total of 69 MACEs (22.85%) and 19 thromboembolism events (6.3%) occurred. Among them, 49 MACEs in the non-AF group (19.92%) while 20 cases (35.71%) occurred MACEs in the AF group (p=0.01). Moreover, the rate of thromboembolism in the AF group was notably higher compared with the non-AF group (16.1% vs. 4.1%, p=0.01). The Kaplan-Meier curves (Figure 1) compared by the log-rank test showed that the AF group was associated with a higher risk of thromboembolism events than the non-AF group and the difference between the 2 groups was significant (p<0.05). Crude Logistic regression model results revealed that AF was associated with increased risk of MACEs in patients with LVNC [Crude odds ratio (OR) 2.23, 95% confidence interval (CI) 1.19–4.19, p=0.01]. Adjusted Logistic regression model indicated that AF was still an independent risk factor (adjusted OR 2.43, 95% CI 1.08–5.45, p=0.03) for MACEs after adjusting for other risk factors including age, heart rate, syncope, heart failure, NYHA class, cardio-pulmonary resuscitation history, hypertension, prior stroke, prior system embolism, family history of cardiomyopathy, levels of NT-pro-BNP, left atrial diameter, left ventricular ejection fraction, oral anticoagulant therapy and antiplatelet therapy. Conclusion This current study indicated that AF is associated with a worse prognosis in patients with LVNC. Extra attention is needed in clinical practice for LVNC patients with AF. Funding Acknowledgement Type of funding sources: None.