629 RELATIONSHIP BETWEEN RIGHT/LEFT ATRIAL ECHOCARDIOGRAPHIC PARAMETERS (INCLUDING ATRIAL SPHERICITY) AND OUTCOME IN PATIENTS WITH ATRIAL FIBRILLATION
Authors: Mantovani Marta , Mitri Gerardo De , Righelli Ilaria , Ciavaglia Edoardo , Marconi Irma , Muto Federico , Ceresoli Pietro , Bertolini Rachele , Birtolo Chiara , Francesco Imberti Jacopo , Bonini Niccolo´ , Vitolo Marco , Livio Malavasi Vincenzo , Boriani Giuseppe 
Published: December 2022

Background

Atrial fibrillation (AF) is the most common arrhythmia seen in the daily practice. AF and atrial remodeling share a biunivocal link, been one cause and effect of the other. Usually we evaluate the remodeling by measuring atrial dimensions.

Aim

Aim of the analysis was to evaluate the power of left atrial (LA) antero-posterior diameter (LAAPD), LA volume indexed for body surface area (LAVI), LA sphericity index (LASI), right atrial (RA) antero-posterior diameter (RAAPD), RA volume indexed for body surface area (RAVI), RA sphericity index (RASI) in predicting a primary endpoint (CEP2) (a composite of all-cause death, any thromboembolism, any acute coronary syndrome or unplanned revascularization). A secondary endpoint (CEP 3) was also evaluated adding to the primary endpoint unplanned admissions for acute heart failure or major or clinically relevant non-major bleeding.

Methods

Starting from 2016 to 2021, patients with ECG-documented AF within 1 year were enrolled in a prospective registry. Patients were not required to be in AF at the time of enrollment, nor AF to be the reason for admission/consultation. We retrieved echocardiographic (echo) data by reviewing clips, when available; we prospectively collected clinical and laboratory data. Patients were followed up after 1 month and usually every 6 months unless complications occurred.

Results

From the original dataset, we analyzed 489 (51.8%) patients with a complete echo evaluation. They were 300 males (61.3%), median age 75 (IQR 66-80) years, median CHA2DS2VASc 3 (2-5), median HAS-BLED 1 (1-2). Four-hundred fifthy-one (92.2%) were anticoagulated. After a median follow-up of 1114 (392-1384) days, 84 (17.2%) patients died, 115 (23.5%) achieved the CEP2, and 189 (38.7%) the CEP3. At Cox regression analysis for the CEP2, adjusted for CHA2DS2VASc, AF type and OAC pattern, LA parameters only were predictive of a worse outcome (LAAPD HR 1.04; 95%CI 1.02-1.05; LAVI HR 1.01 95%CI 1.005-1.05; LASI HR 5.29 95%CI 1.02-27.71); RA parameters were not significantly associated with the outcome. The same results were obtained with CEP3, adjusting the Cox regression for CHA2DS2VASc, AF type, OAC pattern and renal function (LAAPD HR 1.03 95%CI 1.02-1.05; LAVI HR 1.00 95%CI 1.00-1.01; LASI HR 6.00 95%CI 1.62-22.21) (Table.). At ROC curves analysis the AUC were moderately significant, all beeing lower than 0.7; either for CEP2 and CEP3 the better predictive value was seen for LAAPD and LAVI. Taking LAAPD as reference and comparing it with other atrial parameters, LAAPD was not statistically different only for LAVI

Table.

Conclusions

In “real world” patients with AF, LA sphericity and other LA parameters are significantly associated with outcome, while this association is lacking for RA parameters. This finding reinforces the need of comprehensive clinical and echo evaluation of AF in clinical practice.