Ródenas-Alesina Eduard, Lozano-Torres Jordi, Tobías-Castillo Pablo Eduardo, Badia-Molins Clara, Vila-Olives Rosa, Calvo-Barceló Maria, Casas Guillem, Soriano-Colomé Toni, San Emeterio Aleix Olivella, Fernández-Galera Rubén, Méndez-Fernández Ana B, Barrabés José A, Ferreira-González Ignacio, Rodríguez-Palomares José
Department of Cardiology, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Eur Heart J Imaging Methods Pract. 2024 Jun 25;2(1):qyae063. doi: 10.1093/ehjimp/qyae063. eCollection 2024 Jan.
Atrial fibrillation (AF) is a common comorbidity in non-ischaemic dilated cardiomyopathy (NIDCM) affecting conventional measures of left atrial (LA) function. We aimed to determine whether LA function analysis could identify patients at higher risk of major cardiovascular events (MACEs).
A retrospective study of patients with NIDCM in AF referred to a single centre for transthoracic echocardiography (TTE) between 2015 and 2019. Peak atrial longitudinal strain (PALS) was measured along with LA emptying fraction and LA filling index (LAFI = E wave/PALS). Cox regression analysis was conducted. A total of 153 patients were included [median age 74 years, left ventricular ejection fraction (LVEF) 35%], and 57 (37.3%) had MACE after a median follow-up of 3.2 years. LAFI was the only independent TTE parameter associated with MACE after adjustment for age, diabetes, LVEF, left ventricular global longitudinal strain (LV-GLS), and LA volume index [adjusted hazard ratio (HR) = 1.02 per point increase, = 0.024], with the best cut-off at ≥15. LAFI ≥15 predicted each of MACE components when separately analysed: MACE HR = 1.95, 95% confidence interval (CI) 1.16-3.30; cardiovascular death HR = 3.68, 95% CI 1.41-9.56, heart failure admission HR = 2.13, 95% CI 1.19-3.80, and ventricular arrhythmia HR = 4.72, 95% CI 1.52-14.67. Higher LAFI was associated with worsening LV-GLS, /', systolic pulmonary artery (PA) pressure, tricuspid annular plane systolic excursion, and right ventricular to PA coupling.
LA deformation analysis is feasible in patients with NIDCM presenting with AF. LAFI may identify patients at higher risk of MACE and correlates with higher pulmonary pressures and worse right ventricular function, suggesting an elevation of left-sided ventricular pressures in patients with higher LAFI.
心房颤动（AF）是非缺血性扩张型心肌病（NIDCM）的常见合并症，会影响左心房（LA）功能的传统测量指标。我们旨在确定LA功能分析是否能够识别发生主要心血管事件（MACE）风险较高的患者。
对2015年至2019年间因AF合并NIDCM而转诊至单一中心进行经胸超声心动图（TTE）检查的患者进行回顾性研究。测量心房纵向应变峰值（PALS）以及LA排空分数和LA充盈指数（LAFI = E波/PALS）。进行Cox回归分析。共纳入153例患者[中位年龄74岁，左心室射血分数（LVEF）为35%]，中位随访3.2年后，57例（37.3%）发生了MACE。在对年龄、糖尿病、LVEF、左心室整体纵向应变（LV-GLS）和LA容积指数进行校正后，LAFI是唯一与MACE相关的独立TTE参数[校正后风险比（HR）=每增加1个单位为1.02，P = 0.024]，最佳截断值为≥15。单独分析时，LAFI≥15可预测MACE的各个组成部分：MACE的HR = 1.95，95%置信区间（CI）为1.16 - 3.30；心血管死亡的HR = 3.68，95%CI为1.41 - 9.56，心力衰竭住院的HR = 2.
