scholarly journals Derivation and validation of a novel score to detect heart failure with preserved ejection fraction in patients with atrial fibrillation: the Fushimi AF registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Aono ◽  
M Iguchi ◽  
H Ogawa ◽  
S Ikeda ◽  
K Doi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Left Atrial ◽  
Heart Diseases ◽  
Preserved Ejection Fraction ◽  
Left Atrial Enlargement ◽  
Factors Associated ◽  
Atrial Enlargement

Abstract Background Heart failure with preserved ejection fraction (HFpEF) is an important comorbidity of atrial fibrillation (AF). However, it is sometimes difficult to detect HFpEF among AF patients with preserved EF, since AF and HF share similar symptoms. Purpose The aim of this study was to identify factors associated with having HFpEF in AF patients with preserved EF, and derive a new score for HFpEF in AF patients. Methods The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto, Japan. Follow-up data were available for 4,466 patients, and 3,083 patients had preserved EF (≥50%). Of the 3,083 patients, 444 had prior HF hospitalization at baseline and we defined these patients as HFpEF. We examined the factors associated with having HFpEF, and derived a new score for detecting HFpEF in AF patients. Thereafter, we validated this score in patients without prior HF hospitalization. Result The mean age of the patients with EF ≥50% was 73.6 years, and 41.3% were female. Compared with the patients without prior HF hospitalization, HFpEF patients were older, more often female, less in body weight, had more heart disease (valvular heart disease, cardiomyopathy, old myocardial infarction, and coronary artery disease), chronic kidney diseases (CKD), anemia (Hb <11 g/dL), sustained AF (persistent or permanent), left atrial enlargement (>45 mm), and dilation of cardio-thoracic ratio (CTR) (>54%) at baseline. In multivariate analysis, heart diseases, CKD, sustained AF, dilatation of CTR, left atrial enlargement, and anemia were significantly associated with HFpEF (Table 1). We derived a new score to diagnose HFpEF in AF patients (2 points for heart diseases, 1 point for CKD, sustained AF, dilatation of CTR, left atrial enlargement, and anemia; range 0 to 7 points). In a receiver-operating characteristic curve, optimal cut-off point for detecting HFpEF was 3 (Figure 1). We validated this score in patients without prior hospitalization for HF (n=2,639). Of these, 298 patients had HF symptoms of NYHA 2–4 (Symptomatic-HF), and 2,341 patients had neither prior HF hospitalization nor HF symptoms (No-HF). Notably, 207 patients (69.5%) in symptomatic-HF group and 748 patients (32.0%) in No-HF group were classified into HFpEF based on this new score. Furthermore, patients diagnosed as HFpEF by this score had higher incidence of new hospitalization for HF during the follow-up in both symptomatic-HF group and No-HF group. (Figure 2). Conclusion We derived a new score to diagnose HFpEF in AF patients based on the presence of prior HF hospitalization (2 points for heart diseases, 1 point for CKD, sustained AF, dilatation of CTR, left atrial enlargement, and anemia). In patients without prior HF hospitalization, sizable number of patients had high HFpEF score (≥3), and those patients showed higher incidence of new HF hospitalization. Funding Acknowledgement Type of funding source: None

scholarly journals The clinical and etiological profile of atrial fibrillation after echocardiography in a tertiary care centre from North India - a cross sectional observational study

2017 ◽  
Vol 5 (3) ◽  
pp. 847 ◽  
Author(s):  
Ranvijay Singh ◽  
Rajesh Kashyap ◽  
Rajeev Bhardwaj ◽  
Rajeev Marwaha ◽  
Manish Thakur ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Tertiary Care ◽  
Hypertensive Heart Disease ◽  
Atrial Appendage ◽  
North India ◽  
Left Atrial Enlargement ◽  
Atrial Enlargement

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. In western countries, rheumatic heart disease (RHD) is a rare cause of atrial fibrillation but in developing countries like India it is one of the commonest cause of atrial fibrillation. We studied etiology, left atrial size and the incidence of left atrial appendage clot in patients with atrial fibrillation at our institution so that guidelines could be formulated to manage the patients of AF in the hours of emergency.Methods: 110 consecutive patients of atrial fibrillation coming to emergency, cardiology and medicine outpatient department over a period of one year were enrolled for the study. Ethical committee clearance was taken. Detailed history were taken, clinical presentation reviewed  and examination were carried out. All patients were subjected to transthoracic echocardiography and for transesophageal echocardiography if required.Results: The mean age of patients in the study was 58.42±14.27 years (range 22-90 years). Maximum numbers of patients were in the age group of 61-70 years (26.37%). Out of 110 patients with atrial fibrillation, 72 patients (65.46%) were females and 38 patients (34.54%) were males. Majority of patients presented with more than one symptom. Out of 110, 66 patients (60%) had RHD. Among RHD patients, 50 patients (45.55%) were females and 16 patients (14.55%) were males. Next common causes were hypertensive heart disease and degenerative valvular heart disease.Conclusions: In our study RHD was the most common cause of atrial fibrillation, followed by hypertensive heart disease and degenerative valvular heart disease. Mitral valve involvement was seen in all patients of RHD. Left atrial enlargement was seen in majority of patients, so left atrial enlargement could be a predictor of atrial fibrillation. Patients of left atrial enlargement are more prone to develop left atrial appendage clot.

Abstract 12799: Left Atrial Enlargement is an Independent Risk Factor of Stroke or Systemic Embolism in Atrial Fibrillation Patients: The Fushimi AF Registry

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yasuhiro Hamatani ◽  
Daisuke Takagi ◽  
Hisashi Ogawa ◽  
Masahiro Esato ◽  
Yeong-Hwa Chun ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Left Atrial ◽  
Systemic Embolism ◽  
Left Atrial Diameter ◽  
Left Atrial Enlargement ◽  
Valvular Heart Diseases ◽  
Increased Risk ◽  
Atrial Enlargement

Introduction: Atrial fibrillation (AF) is a common arrhythmic disorder and increasing significantly. Stroke or systemic embolism (SE) is a devastating complication of AF. Controversy exists regarding whether left atrial enlargement is a risk factor of stroke/SE in AF patients. Hypothesis: Left atrial enlargement might be associated with the incidence of stroke/SE. Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in Fushimi-ku, which represented a typical urban community in Japan. We started to enroll patients from March 2011, and follow-up data were available for 2,724 patients by April 2015 (median follow-up period 808 days). Left atrial enlargement (LAE) was diagnosed if the left atrial diameter measured by transthoracic echocardiography was >45 mm. We compared the backgrounds and incidences of events during follow-up period between those with LAE and those without it (non-LAE). Results: Backgrounds and incidences of events between LAE and non-LAE are shown in the Table. LAE group showed higher incidence of stroke/SE during follow-up period, compared with non-LAE group (hazard ratio (HR): 1.81, 95% confidence interval (CI): 1.29-2.57, p<0.01). After adjustment by the components of CHADS2 score and oral anticoagulant prescription, LAE was independently associated with higher risk for stroke/SE (HR: 1.70, 95% CI: 1.20-2.43, p<0.01). This was also the case when we defined cut-off as 40 mm (HR: 1.67, 95% CI: 1.12-2.55, p=0.01), and as 50 mm (HR: 1.58, 95% CI: 1.08-2.29, p=0.02), or we analyzed left atrial diameter as continuous variables (HR (per 1mm): 1.03, 95% CI: 1.01-1.05, p<0.01). Even after adjustment by type of AF (paroxysmal or sustained) and valvular heart diseases, LAE remained to be independently associated with the risk of stroke/SE (HR: 1.57, 95% CI: 1.08-2.31, p=0.02). Conclusion: Left atrial enlargement was independently associated with the increased risk of stroke/SE in AF patients.

P2636Stage B predictors of non-ischemic heart failure in type 2 diabetes mellitus

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Klabnik ◽  
J Murin
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Left Atrial ◽  
Systolic Dysfunction ◽  
Left Atrial Enlargement ◽  
Atrial Enlargement

Abstract Purpose Stage B heart failure (SBHF), defined as LV hypertrophy (LVH) and impaired ejection fraction (EF), is precursor of reduced (HFrEF), mid-range (HFmrEF) or preserved (HFpEF) heart failure in type 2 diabetes mellitus (T2DM). Left atrial enlargement (LAE) and left ventricular diastolic or systolic dysfunction (assessed with tissue doppler and speckle-tracking echocardiography) are not accepted as HF stage B equivalents. Methods 396 consecutive community-based elderly (≥65 years) patients (pts) with asymptomatic T2DM (age 76±4 years; 64% women) with preserved EF (≥40%) and no atrial fibrillation, ischemic or valvular heart disease referred to echolab and prospectively followed from January 2015 by regional cardiologist. Results Prevalence of SBHF was observed in 6% after 2 years (EF≤40%) and LVH have 13% at baseline and 20% pts after 2 years. Left atrial enlargement (>34 ml/m2) occurs in 31%, resp. 48% pts after 24 months, diastolic dysfunction (E/e' >14) in 42%, resp. 68%. Systolic dysfunction (S' ≤6.0 cm/s) was observed in 20%, resp. 33% pts, and reduced global longitudinal (GLS <16%) in 23%, resp. 40% pts (all p<0.001). After a mean follow-up of 31±4 months developed new HF 19% pts (1% HFrEF, 6% HFmrEF and 12% HFpEF). The strongest predictors of incident HFpEF were older age (15%, 45% among men and 20%, 60% among women ages 65–74, and 75–85 years, p<0.001), new-onset atrial fibrillation: hazard ratio (HR) 1.4, p<0.01, and NTproBNP >125 pg/ml (HR 2,8, p<0.001). Significant (p<0.001) echocardiografic predictors of incident HFpEF were LVH (HR 2.90), systolic dysfunction (S' ≤6.0 cm/s, HR 2.2) and reduced GLS (HR 2.38). But not abnormal E/e' and LAE were associated with incident HF. Conclusions New echocardiographic parameters are useful in prediction of incident HF and should be added to standard SBHF criteria in asymptomatic patients with type 2 diabetes mellitus. Additional research is needed to update HF screening guidelines. Acknowledgement/Funding Supported by grant from the Slovak Society of Cardiology 2015 Selective screening of heart failure stages in regional settings

Catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O.M Aldaas ◽  
F Lupercio ◽  
C.L Malladi ◽  
P.S Mylavarapu ◽  
D Darden ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Meta Analysis ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure ◽  
One Year

Abstract Background Catheter ablation improves clinical outcomes in symptomatic atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the role of catheter ablation in HF patients with a preserved ejection fraction (HFpEF) is less clear. Purpose To determine the efficacy of catheter ablation of AF in patients with HFpEF relative to those with HFrEF. Methods We performed an extensive literature search and systematic review of studies that compared AF recurrence at one year after catheter ablation of AF in patients with HFpEF versus those with HFrEF. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method for dichotomous variables, where a RR&lt;1.0 favors the HFpEF group. Results Four studies with a total of 563 patients were included, of which 312 had HFpEF and 251 had HFrEF. All patients included were undergoing first time catheter ablation of AF. Patients with HFpEF experienced similar recurrence of AF one year after ablation on or off antiarrhythmic drugs compared to those with HFrEF (RR 0.87; 95% CI 0.69–1.10, p=0.24), as shown in Figure 1. Recurrence of AF was assessed with electrocardiography, Holter monitoring, and/or event monitoring at scheduled follow-up visits and final follow-up. Conclusion Based on the results of this meta-analysis, catheter ablation of AF in patients with HFpEF appears as efficacious in maintaining sinus rhythm as in those with HFrEF. Funding Acknowledgement Type of funding source: None

Abstract 14344: Prognostic Factors of Atrial Fibrillation Patients With Coronary Artery Disease: The Fushimi Af Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nobutoyo Masunaga ◽  
Hisashi Ogawa ◽  
Yuya Aono ◽  
Syuhei Ikeda ◽  
KOSUKE DOI ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Prognostic Factors ◽  
Major Bleeding ◽  
Cardiac Death ◽  
Cardiovascular Events ◽  
Factors Associated ◽  
Artery Disease

Background: Atrial fibrillation (AF) patients are likely to have concomitant coronary artery disease (CAD). A new strategy of antithrombotic therapy in AF patients with stable CAD was demonstrated in recent randomized clinical trials. Now that antithrombotic therapy for AF patients with CAD has reached a major turning point, it is important to know the prognostic factors in those patients. Purpose: In this study, we investigated clinical characteristics, cardiovascular events and prognostic factors in AF patients with CAD. Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients who visited the participating medical institutions in Fushimi-ku, Kyoto, Japan. Follow up data including prescription status were available in 4,441 patients from March 2011 to November 2019. Of 4,441 patients, 645 patients had a history of CAD at enrollment. Results: The mean age was 76.4±8.6 and 65.9% were male. Averages of CHA 2 DS 2 -VASc score and HAS-BLED score were 4.41 and 2.35, respectively. Oral anticoagulant (OAC) was prescribed in 52.9% of those patients and antiplatelet drug (APD) was prescribed in 70.4%. The combination of OAC and APD was prescribed in 36.0%. During follow-up period (median 1,495 days), cardiac death occurred in 51 patients, composite of cardiac death, myocardial infarction (MI) and stroke in 136, and major bleeding in 77 (1.8, 5.1 and 2.9 per 100 person-years, respectively). In multivariate analysis, factors associated with composite of cardiac death, MI and stroke in AF patients with CAD were low body weight (<=50kg) (hazard ratio [95% confidence interval]; 1.62 [1.07-2.47]), previous stroke (1.69 [1.13-2.52]), heart failure (1.47 [1.02-2.11]), hypertension (0.60 [0.41-0.87]) and diabetes mellitus (1.62 [1.13-2.32]). Furthermore, factors associated with major bleeding in AF patients with CAD were anemia (male: hemoglobin<12 g/dl, female: hemoglobin<11 g/dl) (1.82 [1.09-3.04]) and thrombocytopenia (<150,000 /μL) (3.02 [1.29-7.03]). Conclusion: In Japanese AF patients with CAD, low body weight, previous stroke, heart failure, hypertension and diabetes mellitus were associated with cardiovascular events, and anemia and thrombocytopenia were associated with major bleeding.

scholarly journals Five-Year Outcomes of Heart Failure with Preserved Ejection Fraction

2020 ◽  
Vol 14 (1) ◽  
pp. 18-26
Author(s):  
Cristina Macía-Rodríguez ◽  
Emilio Páez-Guillán ◽  
Vanesa Alende-Castro ◽  
Alba García-Villafranca ◽  
Lara Maria Mateo-Mosquera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Clinical Characteristics ◽  
Hypertensive Heart Disease ◽  
Preserved Ejection Fraction ◽  
Related Factors ◽  
Factors Associated ◽  
Heart Failure Unit ◽  
High Level

Objective: The aim of this study was to describe the clinical characteristics of patients that have had a heart failure with preserved ejection fraction (HF-pEF) and to identify the factors associated with 5-year mortality and readmission. Methods: A prospective cohort study was conducted of patients followed by the Heart Failure Unit of the Internal Medicine Department. Clinical characteristics and outcomes were collected. Univariate and multivariate analyses were performed in order to identify factors associated with 5-year mortality and readmission. Results: A total of 209 patients with HF-pEF were followed, 59.3% of these were women, with a mean age 79 years. The main etiology was hypertensive heart disease and a high level of comorbidity (chronic renal failure, hypertension and atrial fibrillation) was observed. The 5-year mortality was 55.5%; the related variables were anemia (hazard ratio [HR]=1.7; 95% confidence interval [CI]: 1.2-2.5), in patients being treated with statins (HR=0.7; 95%CI 0.5-0.9) and spironolactone (HR= 1.6; 95% CI: 1.1-2.3); 24.5% of patients had >2 admission in 5 years, with the main related factors being atrial fibrillation (HR=2.7; 95%CI: 1.4-5.5), anemia (HR=1.9; 95%CI:1.0-3.3) and were being treated with spironolactone (HR=2.1; 95%CI:1.2-3.7). Conclusion: Patients with HF-pEF are old and present a high level of comorbidity. Furthermore, they have a high 5-year mortality and readmission rate. The only factor associated with lower mortality was the treatment with statins. The use of spironolactone was associated with a higher mortality risk.

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