Echocardiographic predictors of atrial fibrillation in patients with heart failure with preserved ejection fraction

Aims To determine if markers of diastolic dysfunction are associated with atrial fibrillation (AF) development among patients with heart failure with preserved ejection fraction (HFpEF). Methods and results We examined the association of several echocardiographic measures of diastolic dysfunction with incident AF in 573 patients (mean age = 68 ± 9.5 years; 48% men; 79% white) with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial (TOPCAT) who were free of baseline AF. Echocardiograms were analysed at a core laboratory. Incident AF cases were identified by follow-up study electrocardiograms and review of relevant medical records through May of 2013. Over a median follow-up of 3 years, 40 patients developed AF (incidence rate = 2.2 per 100 person years). Increasing values of the E/A ratio [per 0.1 increase: Hazard ratio (HR) = 1.11, 95% confidence interval (CI) = 1.06-1.17], left atrial volume (per 5mL increase: HR= 1.13, 95% CI = 1.03-1.23), and left atrial area (per 5 cm2 increase: HR= 1.51, 95% CI = 1.03-2.22) were associated with greater risk of AF. The risk of AF decreased with increasing peak A wave velocities (per 10 cm/s increase: HR= 0.83, 95% CI = 0.72-0.96). The risk of AF was not materially altered when peak A wave velocity was further adjusted for left atrial volume (HR = 0.83, 95% CI = 0.71-0.96) and area (HR = 0.83, 95% CI = 0.71-0.96). However, the associations of left atrial volume (HR = 1.10, 95% CI = 0.99-1.22) and area (HR = 1.48, 95% CI = 0.96-2.28) were no longer significant when accounting for peak A wave velocity. Conclusion Diastolic parameters of left atrial function possibly are more important markers of AF risk than left atrial dilation in HFpEF.