Left heart geometry changes predict NOAF in patients with hypertension

The changes seen in left heart geometry may be used as a marker to predict the development of new-onset atrial fibrillation (NOAF) in patients with hypertension, suggests a study.

In this retrospective analysis, researchers assessed patients with sinus rhythm who underwent echocardiography at hypertension diagnosis and after 6–18 months between 2006 and 2021 at tertiary care centres in Korea.

Left ventricular hypertrophy (LVH) was defined as LV mass index >115 g/m² in men and >95 g/m² in women, while left atrial enlargement was characterized as LA volume index >42 ml/m². The research team assessed the occurrence of NOAC in relation to changes in LVH and LAE status.

A total of 1,464 patients were analysed, of whom 163 (11.1 percent) developed NOAF during a median surveillance period of 63.8 months.

New-onset LVH (adjusted hazard ratio [aHR], 1.88, 95 percent confidence interval [CI], 1.20–2.94; p=0.006) and LAE (aHR, 1.89, 95 percent CI, 1.05–3.40; p=0.034) significantly predicted NOAF. On the other hand, regression of LVH (aHR, 0.51, 95 percent CI, 0.28–0.91; p=0.022) or LAE (aHR, 0.30, 95 percent CI, 0.15–0.63; p=0.001) correlated with a lower risk of developing NOAF.

Notably, patients with both LVH and LAE at follow-up echocardiography were at greater risk of NOAF (aHR, 4.30, 95 percent CI, 2.81–6.56; p<0.001) than those with either LVH or LAE or with neither.

“Hypertension-induced LVH increases end-diastolic LV pressure and contributes to LAE, which are associated with development of AF,” the researchers said.