Abstract 16494: Cardiac Structure and Function Predict Incident Atrial Fibrillation and Flutter in Patients With HFpEF - Lessons From PARAGON-HF

Introduction: Incident atrial fibrillation and flutter (AFF) are common among patients with heart failure with preserved ejection fraction (HFpEF) portending a worse prognosis. Cardiac echocardiographic predictors of incident AFF in patients with HFpEF are not well known.

Methods: Patients without history of AFF enrolled in the echocardiographic sub-study of the PARAGON-HF trial with adequate image quality were included in this analysis. Cardiac structure and function parameters were measured per the American Society of Echocardiography guidelines. Incident AFF was ascertained during serial trial visits. Multivariable Cox proportional hazards models were used to identify parameters of echocardiography associated with incident AFF and were adjusted for variables previously known to associate with incident AFF (age, heart rate, body mass index and NT-pro-BNP).

Results: Among patients without prior AFF (N=425, 54% women, mean age 71 ± 8 years), 63 developed incident AFF over a median follow-up of 2.8 years (5.4 per 100 person-years). After multivariable adjustment, higher left atrial (LA) volume index (HR: 1.35 per 11.3 ml/m ² , 95% CI: 1.10-1.66, p=0.004), left ventricular mass index (HR: 1.40 per 25.7 g/m ² , 95% CI: 1.09-1.80, p=0.008), septal E/e’ ratio (HR: 1.72 per 6.4 units, 95% CI: 1.29-2.28, p<0.001), and lower septal a’ (HR: 0.48 per 2.0 cm/s, 95% CI: 0.33-0.70, p<0.001) were associated with a significantly higher risk of incident AFF. Furthermore, higher (better) LA reservoir strain (LAsr) (HR: 0.66 per 10.8%, 95% CI: 0.48-0.92, p=0.014) and LA contractile strain (absolute LAsct) (HR: 0.71 per 6.7%, 95% CI: 0.51-0.98, p=0.040) predicted lower risk of incident AFF.

Conclusions: In the PARAGON-HF echocardiographic sub-study, worse diastolic and LA function, larger LA size and higher LV mass were associated with a higher risk of incident AFF.