Prediction model for left ventricular ejection fraction recovery in atrial fibrillation-induced cardiomyopathy

Abstract

Abstract Introduction Arrhythmia-Induced Cardiomyopathy (AIC) is a cardiac disfunction secondary to fast, asynchronous or irregular ventricular contraction. Its diagnosis is usually retrospective, subsequently of the recovery of the left ventricle ejection fraction (LVEF) after controlling the responsible arrythmia (most frequently atrial fibrillation (AF)). Objective Our aim is to try to estimate the recovering of LVEF in patients diagnosed of AIC caused by AF, based on individual baseline characteristics. Methods Retrospective analysis of patients diagnosed with AIC related to AF between January 2015–2022. Clinical and demographic characteristics, as well as echocardiographic parameters prior to diagnosis and after recovery of ventricular function, were assessed. Recovered LVEF (final minus initial LVEF) was calculated in all patients. The best model was selected from the method of all possible equations, the one with the lowest Mallows Cp index, maintaining a sufficiently high multiple correlation coefficient (R2). Results 134 patients with AIC were gathered in this period, 99 of them AF-related. Baseline characteristics are summarized in Image 1. The changes in the values of LVEF, left ventricle end-diastolic diameter and (LVEDD), tricuspid annular plane systolic excursion (TAPSE), which represents both left and right ventricular ejection fraction are showed in Image 2. The LVEF recoveredwith treatment was 22±8,5%. The model was selected using up to 16 potential variables: age, sex, chronic kidney disease (CKD), obesity, enolism, hypertension, diabetes, obstructive sleeping apnoea (OSA), LVEF at the diagnosis, heart rate at diagnosis, angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs), neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists (MRA), ablation performed, rhythm control strategy and the interaction between ablation andrhythm control (the latter being rejected because of collinearity). 32.767 models were estimated. The best model was: Recovered LVEF = 51.79 + 1.15×Female Sex − 1.11×OSA − 4.40×RNI − 091×LVEF at diagnosis + 3.43×Rhythm control. The Cp of the selected model was 2.07 and R2 0.496, which means that 49.6% of individual variability of recovered LVEF was justified by this simple model. After that, we performed an internal control using cross-validation, which did not show significative differences according to the estimation ability of the model (0.496 − 0.474 = 0.022, <10%). Conclusion Female sex, absence of OSA, the lower the LVEF at the diagnosis, the absence of treatment with ARNI and the rhythm control as the treatment strategy predicted higher LEVF recovery in patients with AIC caused by AF, explaining nearly half to the individual variability. Funding Acknowledgement Type of funding sources: None.