Prevalence and severity of atrial cardiomyopathy in patients with recently diagnosed atrial fibrillation and stroke risk factors and its association with early rhythm control: a secondary analysis of EAST-AFNET 4

作者：Andreas Goette, Marc D. Lemoine, Katrin Borof, Ulrich Schotten, Günter Breithardt, A. John Camm, Harry J.G.M. Crijns, Lars Eckardt, Andreas Metzner, Stephan Willems, Antonia Zapf, Renate B. Schnabel, Larissa Fabritz, Paulus Kirchhof · 发表于：EP Europace · 年份：2025 · DOI：10.1093/europace/euaf256 · 被引用次数：15 · 研究领域：Atrial Fibrillation Management and Outcomes、Cardiovascular Disease and Adiposity、Cardiovascular Function and Risk Factors

AIMS: Observational data suggest that atrial cardiomyopathy can precede the clinical diagnosis of atrial fibrillation (AF) and that severe forms of atrial cardiomyopathy render rhythm control therapy futile. The aim was to quantify atrial cardiomyopathy in patients with recently diagnosed AF and to determine possible interactions between atrial cardiomyopathy and early rhythm control therapy in the EAST-AFNET 4 trial. METHODS AND RESULTS: This prespecified analysis of the EAST-AFNET 4 trial quantified baseline atrial cardiomyopathy using left atrial (LA) size, PR interval, and NT-proBNP. Outcomes were compared between atrial cardiomyopathy categories. Interactions between early rhythm control, the randomized therapy in EAST-AFNET 4, and atrial cardiomyopathy were determined. Outcomes included the primary outcome of EAST-AFNET 4 (cardiovascular death, stroke, hospitalization for heart failure or acute coronary syndromes), recurrent AF, and safety outcomes (serious adverse events of special interest or all-cause death). In an exploratory analysis, angiopoietin-2 (ANGPT2) as well as bone morphogenetic protein 10 (BMP10) were assessed to predict atrial cardiomyopathy. Most patients showed signs of atrial cardiomyopathy at baseline [69% with at least mildly elevated LA size, 23% with prolonged PR interval (≥200 ms), 56% with NT-proBNP > 365 pg/mL]. Severe atrial cardiomyopathy, defined as the highest tertile of LA size, PR interval, and NT-proBNP, was associated with higher rates ...