Heart Rhythm · Oct 17, 2025

The predictive power of left atrial reservoir strain for long-term atrial fibrillation in the Atherosclerosis Risk in Communities study

By Sun D, Chan LS, Norby FL et al.

BACKGROUND: Left atrial (LA) function measures from the 2-dimensional echocardiograms are linked to atrial fibrillation (AF) development, but their standalone predictive value remains unclear. OBJECTIVE: This study assessed the standalone predictive power of LA function measures for long-term AF prediction (5 and 10 years). METHODS: We analyzed 5442 older adults (median age 74) from the Atherosclerosis Risk in Communities study without previous AF. Participants were split into training and testing sets (7:3 ratio). We evaluated the standalone predictive performance of LA strain measures (reservoir, conduit, and contraction strain) with and without age for long-term AF. The performance was compared with that of the CHARGE-AF score and a machine learning-based predictive model that incorporates the most important routinely measured echocardiographic parameters with LA strain measures. RESULTS: LA reservoir strain alone achieved a Harrell's C-index of 0.664 and 0.646 for 5- and 10-year AF prediction, improving to 0.677 and 0.663 when combined with age, which outperformed the CHARGE-AF score (0.667 and 0.655) and other LA strain measures. A better predictive performance was achieved by the machine learning-based predictive model, including LA reservoir strain, age, race, and 9 echocardiographic parameters; the C-indexes were 0.732 (0.686-0.777) for 5-year and 0.725 (0.693-0.757) for 10-year prediction. CONCLUSION: The standalone predictive performance of LA reservoir strain for long-term AF risk is comparable with the CHARGE-AF score (11 variables) and slightly lower than that of a machine learning-based model with 12 variables, highlighting the importance of LA reservoir in AF risk prediction.

doi.org/10.1016/j.hrthm.2025.10.029PubMed 41110530Biomarkers