Left ventricular geometry and outcomes in patients with atrial fibrillation: The AFFIRM Trial

Abstract

BackgroundEchocardiographically determined left ventricular hypertrophy (LVH) is a marker of cardiovascular disease related to prognosis and clinical outcomes. We sought to determine if LVH is a measure of outcomes in atrial fibrillation (AF) patients. MethodsWe performed a post-hoc analysis of patients with echocardiographic data enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Trial. Patients were stratified based on gender-adjusted echocardiography derived interventricular septal (IVS) thickness, relative wall thickness (RWT), gender-adjusted LV mass, and type of LV remodeling (normal LV geometry, concentric hypertrophy, eccentric hypertrophy, and concentric remodeling). ResultsOf 4060 patients in AFFIRM, echocardiographic data were available in 2433 patients (60%). Multivariate analysis revealed that LVH defined as moderately or severely abnormal IVS thickness was an independent predictor of both all cause mortality (HR 1.46, 95%CI 1.14–1.86, p=0.003) and stroke (HR 1.89, 95%CI 1.17–3.08, p=0.01). This association was confirmed when IVS thickness was assessed as continuous or categorical variable. Concentric LV hypertrophy was associated with the highest rates of all cause mortality (HR 1.53; 95%CI 1.11–2.12; p=0.009). ConclusionAn easily obtained echocardiographic index of LVH (IVS thickness) may enhance risk stratification of patients with AF, and raise the possibility that LVH regression should be a therapeutic target in this population.