Abstract
Aims: The clinical impact of the type of atrial fibrillation (AF) has not been completely elucidated in non-ischemic cardiomyopathy (NICM). Although the structure and function of the left atrium (LA) provide prognostic information in patients with heart failure, the relationship of the AF type with LA structure and function in NICM is unclear.Methods: Consecutive patients with NICM who underwent cardiac magnetic resonance were evaluated and followed. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for major adverse cardiovascular events (MACE) related to the AF type, such as paroxysmal AF, chronic AF, and new-onset AF (NOAF).Results: Among 625 patients with NICM (mean age, 64.4 ± 14.2 years; women, 39.7%), 133 had a history of AF at baseline; of these, 60 had paroxysmal AF. Each baseline AF type was associated with higher LA volume and lower LA emptying fraction but not with an increased incidence of MACE (p = 0.245). New-onset AF developed in 5.9% of patients with sinus rhythm over a median follow-up period of 609 days, and maximum LA volume was a strong and independent predictor [p < 0.001, area under the ROC curve (AUC): 0.795]. Maximum LA volume was superior to LA emptying fraction and B-type natriuretic peptide (AUC: 0.683 and 0.680, respectively). The use of β-blocker and the age of the patient were associated with the incidence of NOAF (HR: 0.37, 95% CI: 0.16–0.84 and HR: 1.05, 95% CI: 1.01–1.09, respectively). Kaplan–Meier analysis showed that patients with NOAF had a higher incidence of MACE than those with sinus rhythm or baseline AF (p = 0.002). NOAF and LA emptying fraction were independent predictors of MACE (HR: 2.28, 95% CI: 1.20–3.97 and HR: 0.98, 95% CI: 0.96–0.99, respectively) after adjusting for age, sex, body mass index, and diagnosis.Conclusions: Paroxysmal and chronic AF in patients with NICM were not associated with an increased incidence of MACE despite their association with LA volume and function. NOAF was independently associated with poor prognosis. Higher maximum LA volume predicted the onset and lower LA emptying fraction was independently associated with poor prognosis.
Highlights
Atrial fibrillation (AF) results in atrial enlargement and is a major arrhythmia associated with heart failure (HF)
The further etiological diagnosis was made based on the following criteria: left ventricular non-compaction (LVNC); the ratio of non-compacted to compacted myocardium in end-diastole of >2.3 by cardiac magnetic resonance (CMR) [13]; dilated cardiomyopathy (DCM); LV dysfunction and dilatation in the absence of coronary artery disease and specific heart muscle diseases [14]; hypertrophic cardiomyopathy (HCM); LV hypertrophy of ≥15 mm and asymmetric/focal hypertrophy in the absence of another disease that could account for the hypertrophy [15]; cardiac sarcoidosis (CS); fulfilling the guidelines published in 2016 by the Japanese Circulation Society or the characteristic manifestations and positive findings of echocardiography, 18Ffluorodeoxyglucose-positron emission tomography (FDG-PET), or CMR with or without extra CS after exclusion from other known cardiac diseases [16]; cardiac amyloidosis (CA); and histological confirmation of amyloidosis by tissue biopsies
The following characteristics were different between the Chronic AF (CAF) and Paroxysmal AF (PAF) groups: proportion of women; estimated glomerular filtration rate (eGFR); NYHA class ≥ II; medications, including diuretics, anticoagulants, and amiodarone; resting hazard ratios (HRs); Left atrial (LA) diameter; and frequent moderate or greater mitral regurgitation (MR)
Summary
Atrial fibrillation (AF) results in atrial enlargement and is a major arrhythmia associated with heart failure (HF). A recent study reported that new-onset AF (NOAF) was associated with poor prognosis in acute coronary syndrome [2]. Previous studies reported conflicting findings regarding whether baseline AF is an independent predictor of poor prognosis in patients with HF [4]. NICM, which leads to a decline in cardiac function, results in HF and severe arrhythmic events [5, 6]. The relationship of these outcomes with AF types has not been fully elucidated in NICM, and several factors have been reported, novel predictive factors for the onset of AF need to be explored to prevent the onset of NOAF
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