Anton Stanchev, Jacob Christensen, Filip Soeskov Davidovski, Caroline Espersen, Morten Sengeløv, Cecilie Johnsen, Burcu Tas Özbek, Peter Godsk Jørgensen, Manan Pareek, Niels Eske Bruun, Thomas Fritz-Hansen, Tor Biering-Sørensen
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Prognostic value was assessed with Cox proportional hazards regressions. Effect modification by sex, valve disease, and LA enlargement was assessed using interaction terms.</p><p><strong>Results: </strong>The final study population consisted of 452 subjects (mean age 65.5±11.8 years, male sex 70.1%) free from AF at baseline. During a median follow-up of 9.4 years [IQR: 5.2, 12.7], 118 (26.1%) developed AF. These subjects exhibited higher LAVi, while LAEF, PALS, and PACS were all significantly lower. All three measures of LA function were significantly associated with incident AF in univariable and adjusted Cox regression analysis (Adjusted analysis: LAEF: HR 1.03 per 1% decrease, 95% CI 1.02-1.04, p=0.009, PALS: HR 1.06 per 1% decrease, 95% CI 1.04-1.09, p=0.037, PACS: HR 1.07 per 1% decrease, 95% CI 1.03-1.10, p=0.021). The prognostic value of LAEF was modified by sex and valve disease (p for interaction=0.007 and 0.041, respectively), while the value of PACS was modified by valve disease (p for interaction=0.011).</p><p><strong>Conclusion: </strong>Impaired PALS, LAEF, and PACS were all associated with an increased risk of incident AF in outpatients with HFrEF.</p>","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":6.7000,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Measures of left atrial function and risk of incident atrial fibrillation in patients with heart failure with reduced ejection fraction.\",\"authors\":\"Anton Stanchev, Jacob Christensen, Filip Soeskov Davidovski, Caroline Espersen, Morten Sengeløv, Cecilie Johnsen, Burcu Tas Özbek, Peter Godsk Jørgensen, Manan Pareek, Niels Eske Bruun, Thomas Fritz-Hansen, Tor Biering-Sørensen\",\"doi\":\"10.1093/ehjci/jeaf205\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Measures of left atrial (LA) function have demonstrated prognostic value in relation to incident atrial fibrillation.</p><p><strong>Aims: </strong>This study aimed to investigate the relationship between measures of LA function and the risk of incident atrial fibrillation (AF) in outpatients with HFrEF.</p><p><strong>Methods: </strong>Subjects were retrospectively included from a HF clinic and followed using the Danish National Patient Registry. Measures included LA emptying fraction (LAEF), peak atrial longitudinal strain (PALS), and peak atrial contractile strain (PACS). Prognostic value was assessed with Cox proportional hazards regressions. Effect modification by sex, valve disease, and LA enlargement was assessed using interaction terms.</p><p><strong>Results: </strong>The final study population consisted of 452 subjects (mean age 65.5±11.8 years, male sex 70.1%) free from AF at baseline. During a median follow-up of 9.4 years [IQR: 5.2, 12.7], 118 (26.1%) developed AF. These subjects exhibited higher LAVi, while LAEF, PALS, and PACS were all significantly lower. All three measures of LA function were significantly associated with incident AF in univariable and adjusted Cox regression analysis (Adjusted analysis: LAEF: HR 1.03 per 1% decrease, 95% CI 1.02-1.04, p=0.009, PALS: HR 1.06 per 1% decrease, 95% CI 1.04-1.09, p=0.037, PACS: HR 1.07 per 1% decrease, 95% CI 1.03-1.10, p=0.021). 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引用次数: 0
摘要
背景：左心房（LA）功能的测量已经证明了与房颤事件有关的预后价值。目的：本研究旨在探讨心房纤颤（HFrEF）门诊患者心房纤颤（AF）发生风险与LA功能的关系。方法：回顾性地从心衰门诊纳入受试者，并使用丹麦国家患者登记处进行随访。测量方法包括左心室排空分数（LAEF）、心房纵应变峰（PALS）和心房收缩应变峰（PACS）。采用Cox比例风险回归评估预后价值。使用相互作用项评估性别、瓣膜疾病和LA增大对效果的影响。结果：最终的研究人群包括452名受试者（平均年龄65.5±11.8岁，男性70.1%）在基线时无房颤。在中位随访9.4年期间[IQR: 5.2, 12.7]， 118例（26.1%）发生AF。这些受试者LAVi较高，而LAEF、PALS和PACS均显著较低。在单变量和校正Cox回归分析中，LA功能的所有三项指标均与AF事件显著相关（校正分析：LAEF：每1%下降HR 1.03, 95% CI 1.02-1.04, p=0.009； PALS：每1%下降HR 1.06, 95% CI 1.04-1.09, p=0.037； PACS：每1%下降HR 1.07, 95% CI 1.03-1.10, p=0.021）。LAEF的预后价值受性别和瓣膜疾病的影响（交互作用p分别为0.007和0.041），PACS的预后价值受瓣膜疾病的影响（交互作用p为0.011）。结论：pal、LAEF和PACS受损均与HFrEF门诊患者发生房颤的风险增加相关。
Measures of left atrial function and risk of incident atrial fibrillation in patients with heart failure with reduced ejection fraction.
Background: Measures of left atrial (LA) function have demonstrated prognostic value in relation to incident atrial fibrillation.
Aims: This study aimed to investigate the relationship between measures of LA function and the risk of incident atrial fibrillation (AF) in outpatients with HFrEF.
Methods: Subjects were retrospectively included from a HF clinic and followed using the Danish National Patient Registry. Measures included LA emptying fraction (LAEF), peak atrial longitudinal strain (PALS), and peak atrial contractile strain (PACS). Prognostic value was assessed with Cox proportional hazards regressions. Effect modification by sex, valve disease, and LA enlargement was assessed using interaction terms.
Results: The final study population consisted of 452 subjects (mean age 65.5±11.8 years, male sex 70.1%) free from AF at baseline. During a median follow-up of 9.4 years [IQR: 5.2, 12.7], 118 (26.1%) developed AF. These subjects exhibited higher LAVi, while LAEF, PALS, and PACS were all significantly lower. All three measures of LA function were significantly associated with incident AF in univariable and adjusted Cox regression analysis (Adjusted analysis: LAEF: HR 1.03 per 1% decrease, 95% CI 1.02-1.04, p=0.009, PALS: HR 1.06 per 1% decrease, 95% CI 1.04-1.09, p=0.037, PACS: HR 1.07 per 1% decrease, 95% CI 1.03-1.10, p=0.021). The prognostic value of LAEF was modified by sex and valve disease (p for interaction=0.007 and 0.041, respectively), while the value of PACS was modified by valve disease (p for interaction=0.011).
Conclusion: Impaired PALS, LAEF, and PACS were all associated with an increased risk of incident AF in outpatients with HFrEF.
期刊介绍：
European Heart Journal – Cardiovascular Imaging is a monthly international peer reviewed journal dealing with Cardiovascular Imaging. It is an official publication of the European Association of Cardiovascular Imaging, a branch of the European Society of Cardiology.
The journal aims to publish the highest quality material, both scientific and clinical from all areas of cardiovascular imaging including echocardiography, magnetic resonance, computed tomography, nuclear and invasive imaging. A range of article types will be considered, including original research, reviews, editorials, image focus, letters and recommendation papers from relevant groups of the European Society of Cardiology. In addition it provides a forum for the exchange of information on all aspects of cardiovascular imaging.
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