Impact of the Fibrosis-4 Index on Risk Stratification of Cardiovascular Events and Mortality in Patients with Atrial Fibrillation: Findings from a Japanese Multicenter Registry.

Yuki Saito,Shoji Hanada,Naoya Matsumoto,Eizo Tachibana,Keiichiro Kuronuma,Daisuke Fukamachi,Motoyuki Onikura,Toshiaki Kojima,Kunio Kondo,Satoru Itou,Kazumasa Sonoda,Yasuo Okumura,Tomobumi Kotani,Toshihiko Nishida,Koji Oiwa,Seiji Fukushima,Yasumi Ohno,Michiaki Matsumoto,Kazumiki Nomoto,Atsushi Hirayama,Koichi Nagashima,Fumiyuki Takahashi,Kimie Ohkubo,Ken Arima,Kenichi Yokoyama ,Hisami Ando

doi:10.3390/jcm9020584

Abstract

Background: Liver diseases drive the development and progression of atrial fibrillation (AF). The Fibrosis-4 (FIB4) index is a non-invasive scoring method for detecting liver fibrosis, but the prognostic impact of using it for AF patients is still unknown. Herein, we evaluated using the FIB4 index as a risk assessment tool for cardiovascular events and mortality in patients with AF. Methods: We performed a post-hoc analysis of a prospective, observational multicenter study. A total of 3067 patients enrolled in a multicenter Japanese registry were grouped as first tertile (FIB4 index < 1.75, n = 1022), second tertile (1.75 ≤ FIB4 index < 2.51, n = 1022), and third tertile (FIB4 index ≥ 2.51, n = 1023). Results: The third tertile had statistically significant results: older age, lower body mass index, increased heart failure prevalence, and lower clearances of hemoglobin and creatinine (all p < 0.05). During the follow-up period, incidences of major bleeding, cardiovascular events, and all-cause mortality were significantly higher for the third tertile (all p < 0.05). After multivariate adjustment, the third tertile associated independently with cardiovascular events (HR 1.72; 95% CI 1.31–2.25) and all-cause mortality (HR 1.43; 95% CI 1.06–1.95). Adding the FIB4 index to a baseline model with CHA2DS2-VASc score improved the prediction of cardiovascular events and all-cause mortality, as shown by the significant increase in the C-statistic (all p < 0.05), net reclassification improvement (all p < 0.001), and integrated discrimination improvement (all p < 0.001). A FIB4 index ≥ 2.51 most strongly associated with cardiovascular events and all-cause mortality in AF patients with high CHADS2 scores (all p < 0.001). Conclusions: The FIB4 index is independently associated with risks of cardiovascular events and all-cause mortality in AF patients.

Highlights

Atrial fibrillation (AF) is currently the most common cardiac arrhythmia, and its prevalence is increasing [1,2]
We examined the potential use of the FIB4 index as a risk assessment tool for both cardiovascular events and mortality in patients with atrial fibrillation (AF)
Of the 3268 patients enrolled in the SAKURA AF Registry, we excluded 31 patients who did not meet the follow-up criteria and another 170 patients that lacked data for one or more of the FIB4 index components (AST, ALT, and platelet count)

Summary

Introduction

Atrial fibrillation (AF) is currently the most common cardiac arrhythmia, and its prevalence is increasing [1,2]. Emerging evidence indicates that liver diseases are closely associated with the development of AF in patients. We evaluated using the FIB4 index as a risk assessment tool for cardiovascular events and mortality in patients with AF. Adding the FIB4 index to a baseline model with CHA2DS2-VASc score improved the prediction of cardiovascular events and all-cause mortality, as shown by the significant increase in the C-statistic (all p < 0.05), net reclassification improvement (all p < 0.001), and integrated discrimination improvement (all p < 0.001). A FIB4 index ≥ 2.51 most strongly associated with cardiovascular events and all-cause mortality in AF patients with high CHADS2 scores (all p < 0.001). Conclusions: The FIB4 index is independently associated with risks of cardiovascular events and all-cause mortality in AF patients

Methods

Results

Discussion

Conclusion