Echocardiographic predictors of de novo atrial fibrillation and clinical outcomes in post-acute myocardial infarction heart failure

Abstract

Abstract Background Despite advances in reperfusion strategies, acute myocardial infarction (AMI) remains a major cause of heart failure. De novo atrial fibrillation (NOAF) occurring in the setting of AMI can be associated with adverse outcomes. Early identification of patients at risk for NOAF remains a clinical challenge. The predictive value of echocardiographic parameters for NOAF in AMI–related heart failure is not fully established.

Purpose To identify echocardiographic predictors of NOAF after AMI and assess its prognostic impact on heart failure and cardiovascular outcomes.

Methods A prospective study included 150 adults with AMI, who were classified according to the occurrence of NOAF (75 pts) during hospitalization or maintenance of sinus rhythm (75 pts). Patients with previous atrial fibrillation, severe non-cardiac comorbidities, cognitive impairment, or substance abuse were excluded. All participants underwent standardized clinical, laboratory, and echocardiographic evaluation. At the 2-year follow-up, patients were assessed for hospitalization for heart failure, all-cause mortality, cardiovascular mortality, stroke, and major bleeding events.

Results In the initial structural echocardiographic assessment, the only parameters significantly associated with NOAF were absolute left atrial volume (59.8 ml vs. 51.2 ml; p < 0.001) and indexed volume (32.9 ml/m² vs. 26.7 ml/m²; p < 0.001), as well as a significant increase in left ventricular end-diastolic diameter (58.6 mm vs. 53.5 mm; p = 0.015). LVEF was lower in the NOAF group—44.0% (95% CI: 20–63) versus 54.0% (95% CI: 28–70) in sinus rhythm, Mann–Whitney test 2059, p = 0.005. HFmrEF was present in 42.7% of NOAF patients (95% CI: 35–51%) versus 38.7% in sinus rhythm (95% CI: 28–50%). HFrEF was observed in 16.0% of NOAF patients (95% CI: 7.7–24%) compared with 1.3% (95% CI: 0–3.9%) in sinus rhythm. LV S’ velocity, was significantly lower in NOAF (median 9.8 cm/s, 95% CI: 4.5–12.0) than in sinus rhythm (10.5 cm/s, 95% CI: 5.6–14.3), Mann–Whitney test 2079, p = 0.006. Right ventricular function was also affected: TAPSE was reduced in NOAF (median 19.0 mm, 95% CI: 15–32) versus 21.0 mm (95% CI: 16–43) in sinus rhythm, Mann–Whitney test 2228, p = 0.026. RV longitudinal systolic velocity S’ was lower in NOAF (median 12.0 cm/s, 95% CI: 7.8–18.0) compared with sinus rhythm (12.5 cm/s, 95% CI: 10.2–18.0), Mann–Whitney test 1900, p < 0.001. At 2-year follow-up, patients with NOAF had higher cardiovascular mortality (18.7% vs. 6.7; p = 0.018) and more frequent hospitalizations for heart failure (37.3% vs. 20.0%; p = 0.030) compared with those in sinus rhythm.

Conclusion Overall, NOAF identifies a heart failure–prone phenotype in which left atrial enlargement emerges as the key structural predictor, accompanied by biventricular systolic impairment and translating into increased cardiovascular mortality and heart failure hospitalizations at 2 years.