Clinical and echocardiographic characteristics of patients with atrial cardiomyopathy and their impact on prognosis

Abstract

Introduction: Patients with diverse demographic and clinical characteristics and comorbidities are included in the category of atrial cardiomyopathy (ACM). Aim: Our study aims to evaluate the demographic, clinical, laboratory, and echocardiographic parameters of patients with ACM and to assess their impact on prognosis. Materials and methods: Only 200 of the 724 consecutively evaluated patients with dilated left atrium who met the criteria for advanced ACM were included in the analysis. Forty age- and sex-matched controls with normal left atrial volume were also included. On enrollment, all patients received a detailed echocardiography with volumetric and speckle tracking analysis, and they were followed for 36 months for cardiovascular outcomes, including mortality. Results: The mean age of the ACM population was 73.91±9.74 years, with 58% being women. Hypertension was found in 93% of them, 79% had atrial fibrillation, 60% had heart failure, 37% were obese, and 26% had diabetes. Over a median follow-up of 20.6 months, 35 deaths were registered in the ACM group compared to 1 death in the control group (17.5% vs. 2%, p=0.011). The presence of heart failure (HR 5.2, p=0.004), cancer (HR 3.7, p=0.007), severe tricuspid regurgitation (TR) (HR 5.4, p<0.001), high NT-proBNP (HR 1.4, p<0.001), and low right ventricular free wall strain (RVFWLS) (HR 1.2, p=0.006) were predictors of poor outcome. Conclusion: In patients with ACM, the most prevalent comorbidities are hypertension, atrial fibrillation, heart failure, obesity, and diabetes. ACM is associated with high mortality with the best echocardiographic predictors – the presence of severe TR and RVFWLS >−17 %.