Small Left Ventricle in AF Patients and Increased CV Risk

May 20, 2024
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Authors:
Li M, Ren L, He L, et al.
Citation:
Small Left Ventricle in Patients With Atrial Fibrillation Is Associated With Increased Cardiovascular Risk. J Am Coll Cardiol 2024;83:1957-1969.
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • Small LV was independently associated with an increased risk of the composite outcome of CV death, embolism, and major bleeding.
  • Of note, a U-shaped association was seen between LV size and adverse CV events.
  • The beneficial effect of catheter ablation in reducing primary CV events remained regardless of LV size.

Study Questions:

What is the association between small left ventricle (LV) and risk of cardiovascular (CV) events in the atrial fibrillation (AF) population?

Methods:

The investigators enrolled 7,764 patients with AF from the China-AF registry and divided them 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 CV events (CV 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%) identified with large LV. Compared to the normal LV group, small LV and large LV were significantly associated with a higher incidence of composite CV events (adjusted hazard ratio [aHR], 1.54; 95% confidence interval [CI], 1.07-2.20 for small LV; aHR, 1.36; 95% CI, 1.02-1.81 for large LV) and CV 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 CV events was identified (p nonlinear < 0.001).

Conclusions:

The authors report that small LV was independently associated with an increased risk of CV events among patients with AF.

Perspective:

This study reports that small LV was independently associated with an increased risk of the composite outcome of CV death, embolism, and major bleeding. Of note, a U-shaped association was seen between LV size and adverse CV events. Importantly, the beneficial effect of catheter ablation in reducing primary CV events remained regardless of LV size. Additional research is needed to identify the pathophysiological mechanisms linking small LVs with adverse clinical outcomes and its role in the risk stratification and management of patients with AF.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Atrial Fibrillation, Catheter Ablation, Heart Ventricles


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