Insights on Distinct Left Atrial Remodeling Between Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction

Jen-Yuan Kuo; Xuanyi Jin; Jing-Yi Sun; Sheng-Hsiung Chang; Po-Ching Chi; Kuo-Tzu Sung; Greta S P Mok; Chun-Ho Yun; Shun-Chuan Chang; Fa-Po Chung; Ching-Hsiang Yu; Tung-Hsin Wu; Chung-Lieh Hung; Hung-I Yeh; Carolyn S P Lam

doi:10.3389/fcvm.2022.857360

Insights on Distinct Left Atrial Remodeling Between Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction

Front Cardiovasc Med. 2022 Apr 26:9:857360. doi: 10.3389/fcvm.2022.857360. eCollection 2022.

Authors

Jen-Yuan Kuo^{1

2

3}, Xuanyi Jin^{4

5}, Jing-Yi Sun⁶, Sheng-Hsiung Chang^{1

3}, Po-Ching Chi⁷, Kuo-Tzu Sung^{1

2

3}, Greta S P Mok⁸, Chun-Ho Yun^{2

3

9}, Shun-Chuan Chang¹⁰, Fa-Po Chung^{11

12}, Ching-Hsiang Yu², Tung-Hsin Wu⁵, Chung-Lieh Hung^{1

2

13}, Hung-I Yeh^{1

2

3}, Carolyn S P Lam^{4

5}

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
² Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
³ Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
⁴ National Heart Centre Singapore, and Duke-National University of Singapore, Singapore, Singapore.
⁵ Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands.
⁶ Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan.
⁷ Division of Cardiology, Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan.
⁸ Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macao, Macao SAR, China.
⁹ Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan.
¹⁰ Holistic Education Center, Mackay Medical College, New Taipei City, Taiwan.
¹¹ Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
¹² Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
¹³ Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan.

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, n = 115), HFpEF alone (n = 59), AF alone (n = 37), and HFpEF+AF (n = 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); p = 0.01] and LAWT(SD) [0.68 (0.61-0.71) vs. 0.60 (0.56-0.65); p < 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.

Keywords: atrial fibrillation; heart failure with preserved ejection fraction; left atrial remodeling; left atrial wall; multi-detector computed tomography; strain.