Author + information
- Received October 23, 2019
- Revision received February 18, 2020
- Accepted April 2, 2020
- Published online October 5, 2020.
- Jin Joo Park, MD, PhDa,∗,
- Jae-Hyeong Park, MD, PhDb,∗,
- In-Chang Hwang, MDa,
- Jun-Bean Park, MD, PhDc,
- Goo-Yeong Cho, MD, PhDa,∗ ( and )
- Thomas H. Marwick, MBBS, PhD, MPHd
- aCardiovascular Center and Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- bDepartment of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- cDepartment of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- dBaker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- ↵∗Address for correspondence:
Dr. Goo-Yeong Cho, Gumiro 166, Bundang, Seongnam, Gyeonggi-do, Republic of Korea.
Objectives This study sought to identify whether left atrial strain can predict new-onset atrial fibrillation (NOAF) in patients with heart failure (HF) and sinus rhythm.
Background Both HF and atrial fibrillation have common risk factors, and HF is a risk factor for the development of atrial fibrillation and vice versa.
Methods Among 4,312 consecutive patients with acute HF from 3 tertiary hospitals, 2,461 patients with sinus rhythm and peak atrial longitudinal strain (PALS) were included in the study. Reduced PALS was defined as PALS ≤18%, and the primary endpoint was 5-year NOAF.
Results During a 5-year follow-up, 397 (16.1%) patients developed NOAF. Patients with reduced PALS had higher NOAF than their counterparts (18.2% vs. 12.7%; p < 0.001). After adjustment for significant covariates, we identified 6 independent predictors of NOAF, including age >70 years (hazard ratio [HR]: 1.50; 95% confidence interval [CI]: 1.12 to 2.00), hypertension (HR: 1.45; 95% CI: 1.10 to 1.91), left atrial volume index ≥40 ml/m2 (HR: 2.03; 95% CI: 1.48 to 2.77), PALS <18% (HR: 1.60; 95% CI: 1.18 to 2.17), HF with preserved ejection fraction (HR: 1.47; 95% CI: 1.11 to 1.95), and no beta-blocker prescription at discharge (HR: 1.48; 95% CI: 1.14 to 1.92). A weighted score based on these variables was used to create a composite score, HAS-BAP (H = hypertension; A = age; S = PALS; B = no beta-blocker prescription at discharge; A = atrial volume index; P = HF with preserved ejection fraction [range 0 to 6] with a median of 3 [interquartile range: 2 to 4]). The probability of NOAF increased with HAS-BAP score.
Conclusions In patients with HF and sinus rhythm, 16.1% developed NOAF, and PALS could be used to predict the risk for NOAF. The HAS-BAP score allows determination of the risk of NOAF. (Strain for Risk Assessment and Therapeutic Strategies in Patients With Acute Heart Failure [STRATS-AHF] Registry; NCT03513653)
↵∗ Drs. Jin Joo Park and Jae-Hyeong Park contributed equally to this work.
This work was supported by grant no. 14-2018-030 from the Seoul National University Bundang Hospital Research Fund. Dr. Marwick has received research gran support for the SUCCOUR study from GE Medical Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received October 23, 2019.
- Revision received February 18, 2020.
- Accepted April 2, 2020.
- 2020 American College of Cardiology Foundation
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