AI Article Synopsis
- The study examines how the left atrial (LA) wall remodeling varies between patients with atrial fibrillation (AF), heart failure with preserved ejection fraction (HFpEF), and those with both conditions.
- Results show that patients with both AF and HFpEF exhibit the most significant LA remodeling and impaired atrial function compared to other groups.
- The findings suggest that while LA enlargement and dysfunction may be similar in HFpEF and AF alone, key differences in LA wall characteristics can help differentiate these conditions, indicating different underlying mechanisms at play.
Article Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) commonly coexist with overlapping pathophysiology like left atrial (LA) remodeling, which might differ given different underlying mechanisms.
Objectives: We sought to investigate the different patterns of LA wall remodeling in AF vs. HFpEF.
Methods: We compared LA wall characteristics including wall volume (LAWV), wall thickness (LAWT), and wall thickness heterogeneity (LAWT[SD]) and LA structure, function among the controls (without AF or HFpEF, = 115), HFpEF alone ( = 59), AF alone ( = 37), and HFpEF+AF ( = 38) groups using multi-detector computed tomography and echocardiography.
Results: LA wall remodeling was most predominant and peak atrial longitudinal strain (PALS) was worst in HFpEF+AF patients as compared to the rest. Despite lower E/e' (9.8 ± 3.8 vs. 13.4 ± 6.4) yet comparable LA volume, LAWT and PALS in AF alone vs. HFpEF alone, LAWV [12.6 (11.6-15.3) vs. 12.0 (10.2-13.7); = 0.01] and LAWT(SD) [0.68 (0.61-0.71) vs. 0.60 (0.56-0.65); < 0.001] were significantly greater in AF alone vs. HFpEF alone even after multi-variate adjustment and propensity matching. After excluding the HFpEF+AF group, both LAWV and LAWT [SD] provided incremental values when added to PALS or LAVi (all p for net reclassification improvement <0.05) in discriminating AF alone, with LAWT[SD] yielding the largest C-statistic (0.78, 95% CI: 0.70-0.86) among all LA wall indices.
Conclusions: Despite a similar extent of LA enlargement and dysfunction in HFpEF vs. AF alone, larger LAWV and LAWT [SD] can distinguish AF from HFpEF alone, suggesting the distinct underlying pathophysiological mechanism of LA remodeling in AF vs. HFpEF.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9086706 | PMC |
| http://dx.doi.org/10.3389/fcvm.2022.857360 | DOI Listing |
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