Francesca Parisi, Eluisa La Franca, Lorenzo Pistelli, Giovanni Gentile, Diego Bellavia, Vincenzo Nuzzi, Paolo Manca, Mulè Massimiliano, Concetta Zito, Gianluca Di Bella, Carerj Scipione, Manlio Cipriani, Faletra Francesco F
Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Therapies (ISMETT), IRCCS, Palermo, Italy.
Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy.
Cardiovasc Ultrasound. 2025 Mar 28;23(1):10. doi: 10.1186/s12947-025-00343-5.
Several predictors of atrial fibrillation (AF) onset in patients with hypertrophic cardiomyopathy (HCM) have been proposed, however, all of them showed limited accuracy. This study aims to assess the role of new echographic parameters in predicting AF onset and major adverse cardiovascular outcomes (cardiovascular death or heart transplantation).
Clinical and imaging data from 141 patients with HCM and without a history of AF were retrospectively analyzed over a 5-year period. Patients who developed AF during the study were compared to those who did not. The analysis focused on key atrial parameters, including the Left Atrial Contraction Index (LACI) and Left Atrial Ejection Fraction (LAEF). LACI was defined as the ratio of left atrial end-diastolic volume to left ventricular end-diastolic volume. Echocardiographic measurements were standardized using cardiac magnetic resonance (CMR) as the reference. Regarding statistical analysis, each significant continuous variable was categorized by identifying a cut-off value using the Youden index. Independent associations with outcomes and cumulative survival were assessed using Cox regression analysis.
Thirty-five patients developed AF, at a mean time of 4 years. The HCM-AF group had significantly higher values of LACI, left atrial diameter (LAD), and left atrial minimum volume (LAVmin). A LACI > 43% on echocardiography and LACI > 44% on CMR showed the best performance in identifying patients at risk for AF. In multivariate analysis, an echocardiographic LAEF < 43% was independently associated with the occurrence of AF (HR 2.9, 95% CI: 1.2-6.9). Additionally, a LAD > 40.5 mm was independently associated with AF onset, with a hazard ratio of 2.5 (95% CI 1.1-5.5). Eleven patients experienced the composite outcome of cardiovascular death or heart transplant, and a LACI > 60% was associated with this outcome.
In patients with HCM, both LACI and LAEF were significantly associated with the occurrence of AF over a 4-year period, demonstrating higher sensitivity and specificity compared to other parameters. A LACI > 60% was also found to be associated with cardiovascular death or heart transplant in this population.
已提出肥厚型心肌病（HCM）患者房颤（AF）发作的几种预测指标，然而，所有这些指标的准确性都有限。本研究旨在评估新的超声心动图参数在预测AF发作和主要不良心血管事件（心血管死亡或心脏移植）中的作用。
回顾性分析141例无AF病史的HCM患者5年期间的临床和影像学数据。将研究期间发生AF的患者与未发生AF的患者进行比较。分析重点关注关键心房参数，包括左心房收缩指数（LACI）和左心房射血分数（LAEF）。LACI定义为左心房舒张末期容积与左心室舒张末期容积之比。超声心动图测量以心脏磁共振成像（CMR）为参考进行标准化。关于统计分析，通过使用约登指数确定临界值对每个显著的连续变量进行分类。使用Cox回归分析评估与结局和累积生存率的独立关联。
35例患者发生AF，平均时间为4年。HCM-AF组的LACI、左心房直径（LAD）和左心房最小容积（LAVmin）值显著更高。超声心动图上LACI>43%和CMR上LACI>44%在识别AF风险患者方面表现最佳。在多变量分析中，超声心动图LAEF<43%与AF的发生独立相关（HR 2.9，95%CI：1.2-6.9）。此外，LAD>40.5 mm与AF发作独立相关，危险比为2.5（95%CI 1.1-5.5）。11例患者经历了心血管死亡或心脏移植的复合结局，LACI>60%与该结局相关。
在HCM患者中，LACI和LAEF在4年期间均与AF的发生显著相关，与其他参数相比具有更高的敏感性和特异性。还发现LACI>60%与该人群的心血管死亡或心脏移植相关。
