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Multicenter Study
. 2024 May 21;83(20):1957-1969.
doi: 10.1016/j.jacc.2024.03.394.

Small Left Ventricle in Patients With Atrial Fibrillation Is Associated With Increased Cardiovascular Risk

Mingxiao Li  1 , Lan Ren  1 , Liu He  1 , Yiwei Lai  1 , Jue Wang  1 , Sitong Li  1 , Xiaodong Peng  1 , Manlin Zhao  1 , Qifan Li  1 , Zixu Zhao  1 , Le Zhou  1 , Chao Jiang  1 , Song Zuo  1 , Xueyuan Guo  1 , Songnan Li  1 , Nian Liu  1 , Chenxi Jiang  1 , Ribo Tang  1 , Deyong Long  1 , Xin Du  2 , Caihua Sang  3 , Jianzeng Dong  4 , Changsheng Ma  5
Affiliations
Free article
Multicenter Study

Small Left Ventricle in Patients With Atrial Fibrillation Is Associated With Increased Cardiovascular Risk

Mingxiao Li et al. J Am Coll Cardiol. .
Free article

Abstract

Background: It is still unclear whether small left ventricle (LV) is an adverse structural prognostic feature in patients with atrial fibrillation (AF).

Objectives: The purpose of this study was to evaluate the association between small LV and risk of cardiovascular events in AF population.

Methods: From the China-AF registry, 7,764 patients with AF were enrolled and divided into groups with normal, small, and large LV size based on left ventricular end-diastolic dimension (LVEDD) measurement per the American Society of Echocardiography references. Cox models were used to assess the association between LV size or LVEDD with composite cardiovascular events (cardiovascular death, ischemic stroke or systemic embolism, or major bleeding).

Results: There were 308 (4.0%) participants assessed with small LV who were older, with lower body mass and blood pressure, and fewer comorbidities, and 429 (5.5%) were identified with large LV. Compared with the normal LV group, small LV and large LV were significantly associated with higher incidence of composite cardiovascular events (adjusted HR [aHR]: 1.54 [95% CI: 1.07-2.20] for small LV; aHR: 1.36 [95% CI: 1.02-1.81] for large LV) and cardiovascular death (aHR: 1.94 [95% CI: 1.14-3.28] for small LV; aHR: 1.83 [95% CI: 1.24-2.69] for large LV). Small LV was also associated with increased risk of major bleeding [aHR: 2.21 [95% CI: 1.01-4.86]). A U-shaped relationship between LVEDD and composite cardiovascular events was identified (Pnonlinear < 0.001).

Conclusions: In a prospective AF cohort, small LV was independently associated with an increased risk of cardiovascular events, which needed consideration in risk stratification and management for patients with AF. (ChiCTR-OCH-13003729).

Keywords: atrial fibrillation; cardiovascular risk; catheter ablation; left ventricle; prospective cohort.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by Beijing Hospitals Authority Yangfan Program (No. ZLRK202315), the National Key Research and Development Program of China (2022YFC3601303), and grant from Science and Technology Program of Guangdong Province (No. 2019B020230004). Dr Ma has received honoraria for presentations from AstraZeneca, Bayer Healthcare, Boehringer Ingelheim, Bristol Myers Squibb, Johnson and Johnson, and Pfizer. Dr Dong has received honoraria for presentations from Johnson and Johnson. All other authors have reported that they have no relationships relevant to the contents of this paper.

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