Aronson Doron, Perlow Daniel, Abadi Sobhi, Lessick Jonathan
Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, 3525422, Israel.
Cardiology Department, Rambam Health Care Campus, Haifa, Israel.
Eur Radiol. 2025 Jul;35(7):3907-3916. doi: 10.1007/s00330-025-11348-z. Epub 2025 Jan 21.
A strong association exists between left atrial (LA) structural remodeling and the development of atrial fibrillation (AF). The role of LA function in AF prediction remains unclear. We studied the relationship between LA function and incident AF using cardiac CT.
We retrospectively analyzed patients who underwent multiphasic cardiac CT. LA volumes and parameters of LA global, reservoir and booster function were calculated. The association between measures of LA function and incident AF was analyzed using multivariable Cox regression adjusting for clinical variables, LA volume and left ventricular function.
1025 patients (age 64 years ± 14) were evaluated. Over a median of 3.9 years, 90 patients developed AF. There was a significant association between LA total emptying fraction (adjusted hazard ratio (HR) 1.05; 95% CI: 1.02-1.05 per 1% decrease, p < 0.001), LA reservoir function (HR 1.04; 95% CI: 1.02-1.06 per 1 mL/m decrease in LA expansion index, p < 0.001) and passive LA emptying (HR 1.08; 95% CI: 1.03-1.13 per 1% decrease in LA passive emptying fraction, p < 0.001) with incident AF, but no association with LA booster function. Incorporating LA function into predictive models improved risk stratification beyond clinical variables and LA volume. Mediation analysis demonstrated that 46% of the effect of LA volume on AF was mediated via LA dysfunction.
LA functional impairment is common even in patients with normal LA volume and provides additional prognostic information for AF risk. The findings underscore the significance of LA mechanical dysfunction in the pathogenesis of AF.
Question A strong association exists between left atrial structural remodeling and incident atrial fibrillation. The role of left atrial function in atrial fibrillation prediction remains unclear. Findings Left atrial reservoir and passive emptying function (but not booster function) predict incident atrial fibrillation independent of left atrial volume and clinical risk factors. Clinical relevance Left atrial functional impairment precedes the development of atrial fibrillation. Measures of left atrial reservoir and passive emptying function are independent predictors of incident atrial fibrillation.
左心房（LA）结构重塑与心房颤动（AF）的发生之间存在密切关联。LA功能在AF预测中的作用仍不明确。我们利用心脏CT研究了LA功能与新发AF之间的关系。
我们回顾性分析了接受多期心脏CT检查的患者。计算LA容积以及LA整体、储存和增强功能的参数。使用多变量Cox回归分析LA功能指标与新发AF之间的关联，并对临床变量、LA容积和左心室功能进行校正。
共评估了1025例患者（年龄64岁±14岁）。在中位时间3.9年期间，90例患者发生了AF。LA总排空分数（校正风险比（HR）1.05；每降低1%，95%置信区间：1.02 - 1.05，p < 0.001）、LA储存功能（HR 1.04；LA扩张指数每降低1 mL/m，95%置信区间：1.02 - 1.06，p < 0.001）和LA被动排空（HR 1.08；LA被动排空分数每降低1%，95%置信区间：1.03 - 1.13，p < 0.001）与新发AF存在显著关联，但与LA增强功能无关。将LA功能纳入预测模型可改善临床变量和LA容积之外的风险分层。中介分析表明，LA容积对AF的影响有46%是通过LA功能障碍介导的。
即使在LA容积正常的患者中，LA功能损害也很常见，并为AF风险提供了额外的预后信息。这些发现强调了LA机械功能障碍在AF发病机制中的重要性。
问题左心房结构重塑与新发心房颤动之间存在密切关联。左心房功能在心房颤动预测中的作用仍不明确。发现左心房储存和被动排空功能（而非增强功能）可独立于左心房容积和临床危险因素预测新发心房颤动。临床意义左心房功能损害先于心房颤动的发生。左心房储存和被动排空功能指标是新发心房颤动的独立预测因素。
