Identification, characterisation and outcomes of pre-atrial fibrillation in heart failure with reduced ejection fraction.
Authors
Affiliations (9)
Affiliations (9)
- Faculty of Medicine and Health, University of Leeds, Leeds, UK.
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK.
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
- Wolfson Institute of Population Health, Queen Mary, University of London, London, UK.
- Department of Cardiology, Mid Yorkshire NHS Trust, Wakefield, UK.
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Abstract
Atrial fibrillation (AF) in heart failure with reduced ejection fraction (HFrEF) has prognostic implications. Using a machine learning algorithm (FIND-AF), we aimed to explore clinical events and the cardiac magnetic resonance (CMR) characteristics of the pre-AF phenotype in HFrEF. A cohort of individuals aged ≥18 years with HFrEF without AF from the MATCH 1 and MATCH 2 studies (2018-2024) stratified by FIND-AF score. All received cardiac magnetic resonance using Cvi42 software for volumetric and T1/T2. The primary outcome was time to a composite of MACE inclusive of heart failure hospitalisation, myocardial infarction, stroke and all-cause mortality. Secondary outcomes included the association between CMR findings and FIND-AF score. Of 385 patients [mean age 61.7 (12.6) years, 39.0% women] with a median 2.5 years follow-up, the primary outcome occurred in 58 (30.2%) patients in the high FIND-AF risk group and 23 (11.9%) in the low FIND-AF risk group (hazard ratio 3.25, 95% CI 2.00-5.28, P < 0.001). Higher FIND-AF score was associated with higher indexed left ventricular mass (β = 4.7, 95% CI 0.5-8.9), indexed left atrial volume (β = 5.9, 95% CI 2.2-9.6), higher indexed left ventricular end-diastolic volume (β = 9.55, 95% CI 1.37-17.74, P = 0.022), native T1 signal (β = 18.0, 95% CI 7.0-29.1) and extracellular volume (β = 1.6, 95% CI 0.6-2.5). A pre-AF HFrEF subgroup with distinct CMR characteristics and poor prognosis may be identified, potentially guiding interventions to reduce clinical events.