scholarly journals Evaluation of ST2 as an early marker of heart failure with a preserved left ventricular ejection fraction in patients with persistent atrial fibrillation

2020 ◽  
Vol 25 (1) ◽  
pp. 72-77
Author(s):  
E. A. Polyanskaya ◽  
N. A. Koziolova ◽  
S. V. Mironova
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Strong Relationship ◽  
Persistent Atrial Fibrillation ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Ventricular Ejection Fraction

Aim. To assess the diagnostic value of soluble ST2 (sST2) for early detection of heart failure with a preserved ejection fraction (HFpEF) in patients with persistent atrial fibrillation (AF).Material and methods. A total of 165 patients hospitalized with AF paroxysm were examined. The inclusion criteria were the persistent AF and LVEF >50% according to echocardiography. A cohort of 60 patients with persistent AF and preserved LVEF was formed. Patients were divided into 2 equal groups of 30 people depending on the HF presence, assessed on the basis of LV diastolic dysfunction with or without left atrial enlargement >34 ml/m2 or left ventricular mass index >110 g/m2 in men and 95 g/m2 in women, as well as an increase in the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) >125 pg/ml. LVEF was calculated using the Simpson method; assessment of LV diastolic function was carried out with determination of transmitral flow velocity characteristics and visualization of mitral annulus motion. The NT-proBNP concentration was determined in blood serum using the Biomedica Group reagent (Austria), sST2 — using Presage ST2 (Critical Diagnostics, USA) by enzyme-linked immunosorbent assay on an Immulite 1000 analyzer (DPC, USA).Results. In patients with HFpEF and persistent AF, the correlation analysis showed a direct strong relationship between NT-proBNP and sST2 (r=0,726; p<0,05). To assess sST2 as a diagnostic criterion for HF, ROC curve was constructed. It was shown that with sST2 ≥16 ng/ml (AUC=0,89), the sensitivity of the method was 80%, the specificity — 83%.Conclusion. In patients with a persistent AF, serum sST2 concentration ≥16 ng/ml can be used as an alternative to the NT-proBNP criterion for early diagnosis of HFpEF.

scholarly journals Prognostic value of atrial fibrillation in patients with heart failure and different left ventricular ejection fraction: results of the multicenter RIF-CHF register

2021 ◽  
Vol 26 (1) ◽  
pp. 4200
Author(s):  
I. V. Zhirov ◽  
N. V. Safronova ◽  
Yu. F. Osmolovskaya ◽  
S. N. Тereschenko
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Cardiovascular Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Number Of Patients ◽  
Increased Risk

Heart failure (HF) and atrial fibrillation (AF) are the most common cardiovascular conditions in clinical practice and frequently coexist. The number of patients with HF and AF is increasing every year.Aim. To analyze the effect of clinical course and management of HF and AF on the outcomes.Material and methods. The data of 1,003 patients from the first Russian register of patients with HF and AF (RIF-CHF) were analyzed. The endpoints included hospitalization due to decompensated HF, cardiovascular mortality, thromboembolic events, and major bleeding. Predictors of unfavorable outcomes were analyzed separately for patients with HF with preserved ejection fraction (AF+HFpEF), mid-range ejection fraction (AF+HFmrEF), and reduced ejection fraction (AF+HFrEF).Results. Among all patients with HF, 39% had HFpEF, 15% — HFmrEF, and 46% — HFrEF. A total of 57,2% of patients were rehospitalized due to decompensated HF within one year. Hospitalization risk was the highest for HFmrEF patients (66%, p=0,017). Reduced ejection fraction was associated with the increased risk of cardiovascular mortality (15,5% vs 5,4% in other groups, p<0,001) but not ischemic stroke (2,4% vs 3%, p=0,776). Patients with HFpEF had lower risk to achieve the composite endpoint (stroke+MI+cardiovascular death) as compared to patients with HFmrEF and HFrEF (12,7% vs 22% and 25,5%, p<0,001). Regression logistic analysis revealed that factors such as demographic characteristics, disease severity, and selected therapy had different effects on the risk of unfavorable outcomes depending on ejection fraction group.Conclusion. Each group of patients with different ejection fractions is characterized by its own pattern of factors associated with unfavorable outcomes. The demographic and clinical characteristics of patients with mid-range ejection fraction demonstrate that these patients need to be studied as a separate cohort.

scholarly journals Early Rhythm Control Therapy in Patients with Atrial Fibrillation and Heart Failure

Circulation ◽  
2021 ◽  
Author(s):  
Andreas Rillig ◽  
Christina Magnussen ◽  
Ann-Kathrin Ozga ◽  
Anna Suling ◽  
Axel Brandes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Heart Failure Patients ◽  
Patients With Heart Failure ◽  
Control Therapy

Background: Even on optimal therapy, many patients with heart failure and atrial fibrillation experience cardiovascular complications. Additional treatments are needed to reduce these events, especially in patients with heart failure and preserved left ventricular ejection fraction (HFpEF). Methods: This prespecified subanalysis of the randomized EAST - AFNET 4 trial assessed the effect of systematic, early rhythm control therapy (ERC; using antiarrhythmic drugs or catheter ablation) compared to usual care (UC, allowing rhythm control therapy to improve symptoms) on the two primary outcomes of the trial and on selected secondary outcomes in patients with heart failure, defined as heart failure symptoms NYHA II-III or left ventricular ejection fraction [LVEF] <50%. Results: This analysis included 798 patients (300 (37.6%) female, median age 71.0 [64.0, 76.0] years, 785 with known LVEF). The majority of patients (n=442) had HFpEF (LVEF≥50%; mean LVEF 61% ± 6.3%), the others had heart failure with mid-range ejection fraction (n=211; LVEF40-49%; mean LVEF 44% ± 2.9%) or heart failure with reduced ejection fraction (n=132; LVEF<40%; mean LVEF 31% ± 5.5%). Over the 5.1-year median follow-up, the composite primary outcome of cardiovascular death, stroke or hospitalization for worsening of heart failure or for acute coronary syndrome occurred less often in patients randomized to ERC (94/396; 5.7 per 100 patient-years) compared with patients randomized to UC (130/402; 7.9 per 100 patient-years; hazard ratio 0.74 [0.56-0.97], p=0.03), not altered by heart failure status (interaction p-value=0.63). The primary safety outcome (death, stroke, or serious adverse events related to rhythm control therapy) occurred in 71/396 (17.9%) heart failure patients randomized to ERC and in 87/402 (21.6%) heart failure patients randomized to UC (hazard ratio 0.85 [0.62-1.17], p=0.33). LV ejection fraction improved in both groups (LVEF change at two years: ERC 5.3%±11.6%, UC 4.9%±11.6%, p=0.43). ERC also improved the composite outcome of death or hospitalization for worsening of heart failure. Conclusions: Rhythm control therapy conveys clinical benefit when initiated within one year of diagnosing atrial fibrillation in patients with signs or symptoms of heart failure. Clinical Trial Registration: Unique Identifiers: ISRCTN04708680, NCT01288352, EudraCT2010-021258-20, Study web site www.easttrial.org; URLs: www.controlled-trials.com; https://clinicaltrials.gov; https://www.clinicaltrialsregister.eu

Atrial function discriminates paroxysmal AF patients with HFpEF from those without HFpEF: subanalysis from AF-RISK study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
V Artola ◽  
B Santema ◽  
R De With ◽  
B Nguyen ◽  
D Linz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Atrial Function ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Left And Right ◽  
Right Atria

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie. Grant support from the Dutch Heart Foundation [NHS2010B233] Background. Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) are two cardiovascular conditions that often coexist. Overlapping symptoms, biomarker profile, and echocardiographic changes hinder the diagnosis of underlying HFpEF in patients with AF and suggest that both conditions might reflect similar remodelling processes in the heart. Purpose. To assess cardiac remodelling in AF patients with versus without concomitant HFpEF by transthoracic echocardiography, focusing on atrial dimension and strain. Methods. We selected 120 patients included in AF-RISK, a prospective, observational, multicentre study aiming to identify a risk profile to guide atrial fibrillation therapy study. Patients had paroxysmal AF diagnosed within three years before inclusion, had a left ventricular ejection fraction (LVEF) ≥50% and were in sinus rhythm at the moment of performing echocardiography and blood sampling. Patients were matched by nearest neighbour by age and sex with a 1:1 ratio and were classified into two groups: 1) AF with HFpEF (n = 60) and 2) AF without HFpEF (n = 60). The diagnosis of HFpEF was based on the 2016 ESC heart failure guidelines, including symptoms and signs of heart failure, N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥125pg/ml, and one of the following echocardiographic measures: left atrium volume index (LAVI) &gt;34ml/m2, left ventricular mass index ≥115g/m2 for men and ≥95g/m2 for women, average E/e’ ≥13cm/s and average e’ &lt;9cm/s. Measurements of reservoir, conduit and contraction strain of both atria were performed in apical four-chamber by echocardiography (GE, EchoPac BT12). Associations of clinical and echocardiographic characteristics were tested for collinearity by multivariable logistic regression analyses. LAVI, LV mass index and NT-proBNP were excluded from multivariable analysis since these markers were part of the HFpEF diagnostic criteria. Results. Patients with paroxysmal AF and concomitant HFpEF had more often hypertension (72% vs. 45%, P = 0.005), had more impaired strain phases of both the left and right atria (figure 1), had comparable LVEF and global longitudinal strain (GLS) (P = 0.168 and P = 0.212, respectively). In a model adjusted for the number of comorbidities and sex, LA contraction decrease was associated with presence of HFpEF (odds ratio per 1% LA contraction-percent was 0.94, 95% confidence interval 0.87–0.99, P = 0.042). LA contraction was not explained by LAVI in patients with concomitant HFpEF (Spearman’s rho= -0.07, P = 0.08). Conclusion. Our results show that atrial function may differentiate paroxysmal AF patients with HFpEF from those without HFpEF. In patients with paroxysmal AF, more impaired strain phases of the left and right atria were associated with concomitant HFpEF, whereas ventricular function, reflected by LVEF and GLS, did not differ. Abstract Figure. Strain distribution of both atria

Abstract 16085: Digoxin is Associated With Increased Mortality in Patients With Atrial Fibrillation Without Concomitant Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Maciej Tysarowski ◽  
Nigri Rafael ◽  
Hyoeun Kim ◽  
Emad Aziz
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Significant Difference ◽  
All Cause Mortality

Introduction: There is conflicting data on the effect of digoxin on all-cause mortality in patients with atrial fibrillation (AF), especially in patients with heart failure (HF). Hypothesis: We hypothesized that in patients with AF, mortality rates associated with digoxin treatment are different among patients with HF and without HF. Methods: We conducted a cohort study of hospitalized patients with AF assessing the effects of digoxin on all-cause mortality. We divided patients into two groups: with and without HF. We performed Cox regression analysis to assess hazard ratios (HR) for all-cause mortality depending on digoxin treatment and used propensity score matching to adjust for differences in background characteristics between treatment groups. Results: Among 2179 consecutive patients, the median age was 73 ± 14 (table), 53% patient were male, 49% had HF, 19% were discharged on digoxin. Median left ventricular ejection fraction in the cohort was 60 (IQR 40-65). Among patients with HF, 35% had preserved, 18% had mid-range and 48% had reduced left ventricular ejection fraction. The mean follow-up time was 3 ± 2.1 years. After adjustment, in patients with HF, there was no statistically significant difference in mortality between the digoxin subgroups ( A , HR=1.01 [95% CI 0.76 to 1.35], p=0.92). In contrast, after adjustment, in patients without HF there was a statistically significant increased mortality in the digoxin subgroup ( B , HR=2.23, [95% CI 1.42 to 3.51], p<0.001). Conclusions: Digoxin use was associated with increased mortality in patients with AF and without concomitant HF. This suggests that clinicians should be careful in prescribing digoxin for rate control in AF, especially in patients without concomitant HF.

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