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

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.857360

DOI=10.3389/fcvm.2022.857360

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>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.</p></sec><sec><title>Objectives</title><p>We sought to investigate the different patterns of LA wall remodeling in AF vs. HFpEF.</p></sec><sec><title>Methods</title><p>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, <italic>n</italic> = 115), HFpEF alone (<italic>n</italic> = 59), AF alone (<italic>n</italic> = 37), and HFpEF+AF (<italic>n</italic> = 38) groups using multi-detector computed tomography and echocardiography.</p></sec><sec><title>Results</title><p>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); <italic>p</italic> = 0.01] and LAWT(SD) [0.68 (0.61–0.71) vs. 0.60 (0.56–0.65); <italic>p</italic> &lt; 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 &lt;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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec>