Supplementary Material for: Echocardiographic Measures of Left Atrial Structure and Function and the Association with Atrial Fibrillation following Acute Coronary Syndrome

Background: Acute coronary syndrome (ACS) is associated with an increased risk of developing atrial fibrillation (AF). This arrhythmia is associated with adverse outcomes making it important to identify high-risk patients. The aim was to evaluate the prognostic value of measures of left atrial (LA) structure and function in AF prediction following ACS. Methods: Three hundred and eighty-one patients who had a percutaneous coronary intervention for ACS were included in the study. Our endpoint was new-onset AF. Results: With a median follow-up time of 5.4 [3.9-6.8] years 56 patients (14.7%) developed AF. Patients developing AF had significantly (P≤0.05) increased maximal and minimal LA volumes (LAVmax and LAVmin, respectively). LAVmax and LAVmin remained significantly increased in AF patients when indexing to either body surface area (LAVmax/BSA and LAVmin/BSA, respectively), left ventricle length in end diastole (LAVmax/LVLd and LAVmin/LVLd, respectively) or late mitral annular diastolic velocity (LAVmax/a’ and LAVmin/a’, respectively) while LA expansion index (LAEi), LA emptying fraction (LAEF) and peak LA longitudinal strain (PALS) were decreased. In univariable cox regressions, all LA measures were found to be predictors of AF. After multivariable adjustment for clinical and echocardiographic parameters all measures reflecting atrial function (LAVmin, LAVmin/BSA, LAVmin/LVLd, LAVmin/a’, LAVmax/a’, LAEF, LAEi and PALS) (P≤0.05) but no structural measures (LAVmax, LAVmax/BSA and LAVmax/LVLd) remained significant independent predictors of AF. Discussion/Conclusion: Echocardiographic measures of LA function are independent predictors of AF following ACS. Evaluation of LA function might improve the prognostic workup, aid in risk stratification for AF and improve selection for further examinations.

背景：急性冠状动脉综合征（ACS）与心房颤动（AF）发病风险升高相关。该心律失常可引发不良临床结局，因此识别高危患者具有重要意义。本研究旨在评估左心房（LA）结构与功能指标在ACS后AF预测中的预后价值。方法：本研究纳入381例因ACS接受经皮冠状动脉介入治疗的患者，研究终点为新发AF。结果：中位随访时间为5.4 [3.9-6.8]年，共56例患者（14.7%）发生AF。发生AF的患者其左心房最大容积（LAVmax）与左心房最小容积（LAVmin）显著升高（P≤0.05）。在校正体表面积（BSA）、舒张末期左心室长度（LVLd）或晚期二尖瓣环舒张速度（a’）后，AF患者的LAVmax与LAVmin仍显著升高；其中以体表面积校正的左心房最大容积（LAVmax/BSA）、最小容积（LAVmin/BSA），以舒张末期左心室长度校正的左心房最大容积（LAVmax/LVLd）、最小容积（LAVmin/LVLd），以及以晚期二尖瓣环舒张速度校正的左心房最大容积（LAVmax/a’）、最小容积（LAVmin/a’）均保持显著升高趋势。而左心房扩张指数（LAEi）、左心房排空分数（LAEF）及左心房纵向峰值应变（PALS）则显著降低。单变量Cox回归分析显示，所有左心房指标均为AF发生的预测因素。在对临床及超声心动图参数进行多变量校正后，所有反映心房功能的指标[LAVmin、LAVmin/BSA、LAVmin/LVLd、LAVmin/a’、LAVmax/a’、LAEF、LAEi及PALS]均为AF发生的独立预测因素（P≤0.05），但结构性指标[LAVmax、LAVmax/BSA及LAVmax/LVLd]则不再具有显著预测价值。讨论/结论：超声心动图评估的左心房功能指标是ACS后AF发生的独立预测因素。对左心房功能进行评估，可优化AF的预后评估流程，辅助开展AF风险分层，并为进一步检查的患者筛选提供依据。