Association of HFA-PEFF Score with Left Atrial Mechanics, Pressure and Reverse Remodeling in Atrial Fibrillation.

BACKGROUND: Diagnosis of heart failure with preserved left ventricular ejection fraction (HFpEF) remains a significant clinical challenge, particularly in patients with atrial fibrillation (AF). Recently, the HFA-PEFF score was introduced to aid in the diagnostic work-up of HFpEF. This study aimed to investigate the distribution of the HFA-PEFF score and its relationship with left atrial (LA) function, pressure, and reverse remodeling in patients with AF. METHODS: We investigated 155 AF patients who underwent their first catheter ablation (CA). Echocardiography was performed before CA, and the HFA-PEFF score was calculated. Direct LA pressure (LAP) was measured at CA. Echocardiography was repeated 6 months after CA to evaluate LA reverse remodeling. RESULTS: High (5-6), intermediate (2-4) and low (0-1) HFA-PEFF scores were observed in 19 (12.3%), 99 (63.9%) and 37 (23.9%) patients, respectively. Higher HFA-PEFF scores were associated with worse LA function and LA stiffness (both P<0.05). Elevated LAP was detected in 31.6%, 19.2%, and 5.4% of the high, intermediate, and low HFA-PEFF score groups, respectively. In the intermediate HFA-PEFF score group, LA stiffness was a good predictor of elevated LAP, whereas left ventricular global longitudinal strain was more predictive in the high HFA-PEFF score group. Six months after CA, all groups exhibited LA reverse remodeling, while the high-score group retained larger LA size and worse LA function. CONCLUSIONS: Higher HFA-PEFF scores were associated with advanced LA functional remodeling and elevated LAP in AF patients. Persistent LA remodeling after CA in the high-score group demonstrates the need for careful follow-up.