P-wave morphology based diagnosis of atrial cardiomyopathy in heart failure with preserved ejection fraction (HFpEF) patients with and without known atrial fibrillation (AF)

Abstract Background Heart failure with preserved ejection fraction (HFpEF) accounts for about 50% of heart failure patients (pts) and atrial cardiomyopathy is common in those pts. The latter is associated with more severe pulmonary vascular disease, right ventricular dysfunction, stroke and an increased risk of incident atrial fibrillation (AF). There is a lack of data concerning the extent of electrical remodeling in HFpEF and ACM pts seen in 12-lead-electrocardiograms (ECG). Purpose This study aims to elucidate the prevalence of atrial cardiomyopathy based on p-wave morphology parameters in pts with HFpEF with known and without previously known AF. Methods We analyzed 152 pts from the German HFpEF registry. Clinical, functional, ECG, and echocardiographic data were collected. To define atrial cardiomyopathy based on ECG parameters (eACM) we used 4 ECG parameters in sinus rhythm (SR) ECGs (n=99): p-wave terminal force in V1 (PTFV1) > (-) 4 ms*mV, p-wave duration (PWD) >120ms, pathological p-vector (P-Vec), and biphasic p-waves in lead II,III+aVF. To confirm eACM diagnosis ≥2 criteria had to be met. We compared ECG parameters in pts with a diagnosis of clinical AF and without previously known AF. Furthermore, it was hypothesized that clinical parameters do not predict the prevalence of eACM. Results Of the 152 HFpEF 91 (60%) had clinical AF (37 pts with paroxysmal AF (41%), 45 pts with persistent (pers) or permanent AF (49%), while 61 pts (40.1%) did not have AF diagnosis. Clinical parameters are depicted in table 1. 30 pts (20%) were in pers AF and 9 (6%) in atrial tachycardias at the time of enrollment in the registry, 14 (9%) showed atrial pacing while in N=99 pts (65%) with SR ECGs p wave morphologies were analyzed (table 2). 40 (40.4%) of these met our diagnostic criterium for eACM (figure 1A). ECG parameters for all HFpEF pts and the subgroups AF/no AF are shown in table 2. Nineteen of the eACM pts (47.5%) had a clinical AF diagnosis while 21 patients (52.5%) did not. The presence of AF did not correlate with the diagnosis of eACM in pts with HFpEF (p=0.738). Except for the CHA2DSV2A score (p=0.020), all clinical parameters were comparable between patients with eACM and those without eACM. The same applies to the left atrial size (p=0.5), 6-min walking test (p=0.6) and NT-ProBNP (p=0.5). CHA2DS2VA score correlated with eACM diagnosis, even though 22.6% (N=7 of 31) of pts with CHA2DSV2A score ≤3 showed eACM (figure 1B). There was no significant difference regarding clinical parameters such as type 2 diabetes (p>0.9), arterial hypertension (p=0.2) and cerebral vascular disease (p=0.2). In addition, there was no significant difference in an anticoagulation requiring (p=0.226). Conclusion eACM is prevalent in patients with HFpEF, regardless of whether they have a prior diagnosis of AF. This finding may influence recommendations for systematic atrial fibrillation screening in HFpEF pts with eACM and could contribute to a reduction in stroke risk.Tabels Figures