Predicting atrial fibrillation progression: risk scores and useful corrections

    Authors

    Abstract

    **Background**: Stratifying patients with paroxysmal or short-term persistent atrial fibrillation (AF) who are at greater risk of developing permanent AF is challenging. There are studies on predicting persistent AF in patients with paroxysmal AF, but studies evaluating natural course of progression to permanent AF are rare. (1, 2) Aim of our prospective study was to evaluate utility of routine demographic, clinical, laboratory and echocardiography parameters, together with evaluated risk scores in prediction of AF progression to a permanent form. **Methods**: In the period of 30 months we prospectively recruited 409 patients with paroxysmal or short-term persistent AF who were treated at discretion of the referral cardiologist in University Hospital Dubrava and followed them for a median follow-up time of 21 months. Clinical, laboratory, and routine echocardiographic parameters were collected. Endpoint was progression to permanent AF when further attempts to restore sinus rhythm were abandoned. **Results**: Out of 409 patients with non-permanent AF, 109 (26.6%) progressed to permanent AF during follow up. Patients who progressed had significantly lower estimated glomerular filtration rate (eGFR), higher age, body mass index, CHA2DS2-VASc score, HATCH score, LADS score, LA diameter, C-reactive protein, red cell distribution width (RDW) and mean platelet volume (MPV) levels, and also higher proportions of arterial hypertension and previous stroke. In multivariate Cox regression model only increased left atrium (LA) diameter, and increased RDW showed significant independent association with progression. When corrected for LA size at 45 mm and RDW level at 14.5% LADS score dichotomized at 0.60. **Conclusion**: LA size and RDW levels strongly moderate estimated risk of AF progression. Although it is still challenging to predict progression, patients with LA size ≤45 mm and RDW level ≤14.5% and a HATCH score <3 had the least probability of AF progression, and are most probably the best candidates for rhythm control strategies.

    Keywords

    atrial fibrillation, risk score

    DOI

    https://doi.org/10.15836/ccar2018.326

    Literature

    1. Heijman J, Voigt N, Nattel S, Dobrev D. Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression. Circ Res. 2014 Apr 25;114(9):1483–99. https://doi.org/10.1161/CIRCRESAHA.114.302226
    2. de Vos CB, Pisters R, Nieuwlaat R, Prins MH, Tieleman RG, Coelen RJ, et al. Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. J Am Coll Cardiol. 2010 Feb 23;55(8):725–31. https://doi.org/10.1016/j.jacc.2009.11.040
    Cardiologia Croatica
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    Predicting atrial fibrillation progression: risk scores and useful corrections

    Extended Abstract
    Issue11-12
    Published
    Pages326
    PDF via DOIhttps://doi.org/10.15836/ccar2018.326
    atrial fibrillation
    risk score

    Authors

    Ivana JurinORCIDKlinička bolnica Dubrava, Zagreb, Hrvatska
    Tomislava Bodrožić Džakić PoljakORCIDKlinička bolnica Dubrava, Zagreb, Hrvatska
    Ana JordanORCIDKlinička bolnica Dubrava, Zagreb, Hrvatska
    Jasmina ĆatićORCIDKlinička bolnica Dubrava, Zagreb, Hrvatska
    Irzal Hadžibegović*ORCIDKlinička bolnica Dubrava, Zagreb, Hrvatska

    *Correspondence email: irzalh@gmail.com

    Abstract

    **Background**: Stratifying patients with paroxysmal or short-term persistent atrial fibrillation (AF) who are at greater risk of developing permanent AF is challenging. There are studies on predicting persistent AF in patients with paroxysmal AF, but studies evaluating natural course of progression to permanent AF are rare. (1, 2) Aim of our prospective study was to evaluate utility of routine demographic, clinical, laboratory and echocardiography parameters, together with evaluated risk scores in prediction of AF progression to a permanent form. **Methods**: In the period of 30 months we prospectively recruited 409 patients with paroxysmal or short-term persistent AF who were treated at discretion of the referral cardiologist in University Hospital Dubrava and followed them for a median follow-up time of 21 months. Clinical, laboratory, and routine echocardiographic parameters were collected. Endpoint was progression to permanent AF when further attempts to restore sinus rhythm were abandoned. **Results**: Out of 409 patients with non-permanent AF, 109 (26.6%) progressed to permanent AF during follow up. Patients who progressed had significantly lower estimated glomerular filtration rate (eGFR), higher age, body mass index, CHA2DS2-VASc score, HATCH score, LADS score, LA diameter, C-reactive protein, red cell distribution width (RDW) and mean platelet volume (MPV) levels, and also higher proportions of arterial hypertension and previous stroke. In multivariate Cox regression model only increased left atrium (LA) diameter, and increased RDW showed significant independent association with progression. When corrected for LA size at 45 mm and RDW level at 14.5% LADS score dichotomized at 0.60. **Conclusion**: LA size and RDW levels strongly moderate estimated risk of AF progression. Although it is still challenging to predict progression, patients with LA size ≤45 mm and RDW level ≤14.5% and a HATCH score <3 had the least probability of AF progression, and are most probably the best candidates for rhythm control strategies.

    Literature

    1. 1.
      Heijman J, Voigt N, Nattel S, Dobrev D. Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression. Circ Res. 2014 Apr 25;114(9):1483–99.DOI
    2. 2.
      de Vos CB, Pisters R, Nieuwlaat R, Prins MH, Tieleman RG, Coelen RJ, et al. Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. J Am Coll Cardiol. 2010 Feb 23;55(8):725–31.DOI