Background: There are conflicting evidence on the association between atrial fibrillation (AF) pattern, such as persistent/permanent (Pers/Perm) and paroxysmal (PAF) AF and risk of ischemic events. We investigated if left atrial diameter (LAd) may affect the risk of cardiovascular outcomes according to AF pattern. Methods: Prospective multicenter observational including 1,252 non-valvular AF patients (533 PAF and 719 Pers/Perm AF). Study endpoints were cardiovascular events (CVEs), major adverse cardiac events (MACE) and CV death. LA anteroposterior diameter (LAd) was obtained by transthoracic echocardiography. Results: Pers/Perm AF patients had a higher proportion of LAd above median than PAF (≥44 mm, 59.5% vs 37.5% respectively, P <.001). In a mean follow-up of 42.2 ± 31.0 months (4,315 patients/year) 179 CVEs (incidence rate [IR] 4.2%/year), 133 MACE (IR 3.1%/year), and 97 CV deaths (IR 2.2%/year) occurred. Compared to patients with LAd below median, those with LAd above the median had a higher rate of CVEs (log-rank test, P <.001), MACE (log-rank test P <.001), and CV death (log-rank test P <.001). Multivariable Cox regression analysis showed that LAd above the median was associated with CVEs, (HR 1.569, 95% CI 1.129-2.180, P =.007) MACE (HR 1.858, 95% CI 1.257-2.745, P =.002) and CV death (HR 2.106, 95% CI 1.308-3.390, P =.002). The association between LAd and outcomes was evident both in PAF and Pers/Perm AF patients. No association between AF pattern and outcomes was found. Conclusion: LAd is a simple parameter that can be obtained in virtually all AF patients and can provide prognostic information on the risk of CVEs, MACE and CV death regardless of AF pattern

Atrial fibrillation pattern, left atrial diameter and risk of cardiovascular events and mortality. a prospective multicenter cohort study / Menichelli, D.; Sciacqua, A.; Cangemi, R.; Andreozzi, P.; Del Sole, F.; Violi, F.; Pignatelli, P.; Pastori, D.; Saliola, M.; Casciaro, M. A.; Vicario, T.; Astorri, G.. - In: INTERNATIONAL JOURNAL OF CLINICAL PRACTICE. - ISSN 1368-5031. - 75:3(2021).

Atrial fibrillation pattern, left atrial diameter and risk of cardiovascular events and mortality. a prospective multicenter cohort study

Menichelli D.;Cangemi R.;Andreozzi P.;Del Sole F.;Violi F.;Pignatelli P.;Pastori D.
;
Saliola M.;Vicario T.;Astorri G.
2021

Abstract

Background: There are conflicting evidence on the association between atrial fibrillation (AF) pattern, such as persistent/permanent (Pers/Perm) and paroxysmal (PAF) AF and risk of ischemic events. We investigated if left atrial diameter (LAd) may affect the risk of cardiovascular outcomes according to AF pattern. Methods: Prospective multicenter observational including 1,252 non-valvular AF patients (533 PAF and 719 Pers/Perm AF). Study endpoints were cardiovascular events (CVEs), major adverse cardiac events (MACE) and CV death. LA anteroposterior diameter (LAd) was obtained by transthoracic echocardiography. Results: Pers/Perm AF patients had a higher proportion of LAd above median than PAF (≥44 mm, 59.5% vs 37.5% respectively, P <.001). In a mean follow-up of 42.2 ± 31.0 months (4,315 patients/year) 179 CVEs (incidence rate [IR] 4.2%/year), 133 MACE (IR 3.1%/year), and 97 CV deaths (IR 2.2%/year) occurred. Compared to patients with LAd below median, those with LAd above the median had a higher rate of CVEs (log-rank test, P <.001), MACE (log-rank test P <.001), and CV death (log-rank test P <.001). Multivariable Cox regression analysis showed that LAd above the median was associated with CVEs, (HR 1.569, 95% CI 1.129-2.180, P =.007) MACE (HR 1.858, 95% CI 1.257-2.745, P =.002) and CV death (HR 2.106, 95% CI 1.308-3.390, P =.002). The association between LAd and outcomes was evident both in PAF and Pers/Perm AF patients. No association between AF pattern and outcomes was found. Conclusion: LAd is a simple parameter that can be obtained in virtually all AF patients and can provide prognostic information on the risk of CVEs, MACE and CV death regardless of AF pattern
File allegati a questo prodotto
File Dimensione Formato  
Menichelli_Atrial-Fibrillation_2021.pdf

solo gestori archivio

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 914.92 kB
Formato Adobe PDF
914.92 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1473364
Citazioni
  • ???jsp.display-item.citation.pmc??? 2
  • Scopus 5
  • ???jsp.display-item.citation.isi??? 6
social impact