scholarly journals Effect of systolic dysfunction and elevated left ventricular end diastolic pressure on 3-year clinical outcomes in patients with atrial fibrillation

2021 ◽  
Author(s):  
YU HYEYON ◽  
JIHUN AHN
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Systolic Dysfunction ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diastolic Filling ◽  
Ventricular Ejection Fraction

Objectives: Systolic and diastolic dysfunctions are related to adverse clinical outcomes in patients with sinus rhythm. The aim of this study was to clarify the prognostic significance of systolic and diastolic dysfunctions in patients with chronic persistent atrial fibrillation (AF). Methods: We evaluated data for 114 consecutive patients with chronic AF who underwent measurement of LVEDP at our hospital between 1 March 2011 and 31 December 2014. In total, 114 consecutive patients with chronic AF were divided into two groups according to the left ventricular ejection fraction (LVEF): LVEF < 50 (reduced ejection fraction, REF group) and LVEF ≥50 (preserved EF, PEF group). The PEF group was further divided into two subgroups according to the left ventricular end-diastolic filling pressure (LVEDP): LVEDP >15 mmHg and LVEDP ≤ 15 mmHg. The 3-year clinical outcomes were compared between the PEF and REF groups and the LVEDP ≥15 mmHg and LVEDP <15 mmHg groups. Results: During the 3-year follow-up period, the rate of heart failure (HF) hospitalisation and incidence of AF with rapid ventricular rhythm (RVR) were higher in the REF group than in the PEF group. Multivariate analysis revealed that REF was the only significant predictor of HF hospitalisation (hazard ratio, 4.71; 95% confidence interval, 1.48–15.02; p=0.009). Conclusions: Our observations during a mid-term follow-up period revealed that systolic dysfunction could be an important predictor of HF hospitalisation in patients with AF. However, elevated LVEDP may not be associated with mid-term adverse clinical outcomes in patients without systolic dysfunction.

scholarly journals P966 Impact of systolic dysfunction and elevated left ventricular end diastolic pressure on three years clinical outcome in patients with atrial fibrillation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Ahn ◽  
H Y Yu
Keyword(s):  
Atrial Fibrillation ◽  
Diastolic Dysfunction ◽  
Clinical Outcomes ◽  
Systolic Dysfunction ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diastolic Filling ◽  
Ventricular Ejection Fraction

Abstract Background Systolic and diastolic dysfunction is related with adverse clinical outcomes in the patients with sinus rhythm. Purpose: The aim of this study is to clarify the prognostic significance of both systolic and diastolic dysfunction in the patients with chronic persistent atrial fibrillation (AF). Methods: A total of 114 consecutive patients who have chronic persistent AF. Whole patients were divided into 2 groups according to left ventricular ejection fraction (LVEF): those with an LVEF &lt; 50 (n = 24) (REF) and those with an LVEF ≥ 50 (n = 90) (PEF). And PEF group was also divided into two groups according to left ventricular end diastolic filling pressure (LVEDP): patients with LVEDP ≥ 15 mmHg (n = 38) and those with &lt; 15 mmHg (n = 52). Results: 3-year clinical outcomes were compared between each groups (PEF groups vs. REF groups and LVEDP ≥ 15 mmHg vs LVEDP &lt; 15 mmHg). The incidence of death, hospitalization, stroke, bleeding, AF with rapid ventricular rhythm (RVR) and heart failure (HF) hospitalization were similar PEF and REF group. However, during 3-year follow up period, the incidence of HF hospitalization (29.2% vs 8.9%, p &lt; 0.02) and AF with RVR (20.8% vs 3.3%, p &lt; 0.01) were frequent in REF group compared with PEF group. In multivariate analysis, REF is an only predictor of HF hospitalization (Table 1). Conclusion: During 3-year follow up period, systolic dysfunction is an important predictor of HF hospitalization in AF patients. However, elevated LVEDP is not related with 3-year adverse clinical outcomes in AF patients without systolic dysfunction. Table 1 variable Odd Ratio (HR) 95% Confidence Interval (CI) P Age .973 .925-1.023 .286 Diabetes mellitus .487 .138-1.721 .264 BNP 1.000 1.000-1.000 .908 Hypertension 1.061 .330-3.413 .921 LVEDP &gt; 15 mmHg 1.302 .396-4.285 .664 EF &lt; 50 4.712 1.478-15.016 .009 Predictors of 3-year follow-up clinical outcomes of all participants

P1025Clinical predictors for the improvement of left ventricular ejection fraction and prognosis after catheter ablation of atrial fibrillation in patients with systolic dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Nagaoka ◽  
Y Mukai ◽  
S Kawai ◽  
S Takase ◽  
K Sakamoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lower Plasma ◽  
Ventricular Ejection Fraction

Abstract Background Catheter ablation (CA) of atrial fibrillation (AF) improves left ventricular ejection fraction (LVEF) and clinical outcomes in patients with left ventricular systolic dysfunction (LVSD). However, predictors of the improvement of LV function and clinical outcomes by CA were poorly understood. Purpose We examined the efficacy of CA in AF patients with LVSD and predictive factors associated with clinical outcomes. Method Among consecutive 795 patients undergone initial RFCA at our hospital, we studied 51 patients with LVSD (LVEF ≤50%). Improved LVEF more then 5% at 1-year after CA was classified as “responder” to CA. We analyzed clinical variables and echocardiographic parameters before and after the CAs. Results In the responder group, LVEF was significantly improved 1-year after catheter ablation compared with the non-responder group. (ΔLVEF 22±12% vs. −1±4%, p<0.001). The responder group was significantly younger, had more non-paroxysmal AF, smaller LV systolic diameter and lower plasma BNP level before CA (Table). Late gadolinium enhancement (LGE)-positive rate in cardiovascular magnetic resonance imaging (CMR) before CA was higher in the non-responder group than in the responder group (100% [6/6] vs. 38% [5/13], p<0.005). After CAs of AF, event-free survival from hospitalization for heart failure was significantly higher in the responder group (Figure) with less AF recurrence (27% vs. 47%, p=0.04) than in the non-responder group. Baseline characteristics Responder (N=35) Non-Responder (N=16) P value Age, y 62±11 69±8 p<0.01 Male, n (%) 26 (74) 13 (76) NS Non-pAF 26 (74) 4 (24) p<0.01 LAD, mm 48±7 48±8 NS LAVI, ml/m2 54±17 58±20 NS LVDd, mm 54±7 58±10 NS LVDs, mm 43±7 48±10 p=0.05 EF, % 37±8 38±8 NS BNP (pg/ml) 278±225 684±848 p<0.05 Conclusion Younger age, absence of LV dilatation, lower plasma BNP, or absence of LGE may well predict favorable clinical outcomes after CA in patients with LVSD.

Prognostic significance of longitudinal strain in dilated cardiomyopathy with recovered ejection fraction

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319504
Author(s):  
Marco Merlo ◽  
Marco Masè ◽  
Andrew Perry ◽  
Eluisa La Franca ◽  
Elena Deych ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Dilated Cardiomyopathy ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death

ObjectivePatients with non-ischaemic dilated cardiomyopathy (NICM) may experience a normalisation in left ventricular ejection fraction (LVEF). Although this correlates with improved prognosis, it does not correspond to a normalisation in the risk of death during follow-up. Currently, there are no tools to risk stratify this population. We tested the hypothesis that absolute global longitudinal strain (aGLS) is associated with mortality in patients with NICM and recovered ejection fraction (LVEF).MethodsWe designed a retrospective, international, longitudinal cohort study enrolling patients with NICM with LVEF <40% improved to the normal range (>50%). We studied the relationship between aGLS measured at the time of the first recording of a normalised LVEF and all-cause mortality during follow-up. We considered aGLS >18% as normal and aGLS ≥16% as of potential prognostic value.Results206 patients met inclusion criteria. Median age was 53.5 years (IQR 44.3–62.8) and 56.6% were males. LVEF at diagnosis was 32.0% (IQR 24.0–38.8). LVEF at the time of recovery was 55.0% (IQR 51.7–60.0). aGLS at the time of LVEF recovery was 13.6%±3.9%. 166 (80%) and 141 (68%) patients had aGLS ≤18% and <16%, respectively. During a follow-up of 5.5±2.8 years, 35 patients (17%) died. aGLS at the time of first recording of a recovered LVEF correlated with mortality during follow-up (HR 0.90, 95% CI 0.91 to 0.99, p=0.048 in adjusted Cox model). No deaths were observed in patients with normal aGLS (>18%). In unadjusted Kaplan-Meier survival analysis, aGLS <16% was associated with higher mortality during follow-up (31 deaths (22%) in patients with GLS <16% vs 4 deaths (6.2%) in patients with GLS ≥16%, HR 3.2, 95% CI 1.1 to 9, p=0.03).ConclusionsIn patients with NICM and normalised LVEF, an impaired aGLS at the time of LVEF recovery is frequent and associated with worse outcomes.

Predictors of relapse after improved ejection fraction in patients with heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.F Esteves ◽  
R Marinheiro ◽  
M Fonseca ◽  
J.M Farinha ◽  
A Pinheiro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Univariate Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Main ◽  
Ventricular Ejection Fraction

Abstract Background Patients with systolic dysfunction with improvement in left ventricular ejection fraction (LVEF) present a more favorable clinical profile when compared to those that maintain dysfunction. However, little is known about the characteristics of patients who “relapse” after LVEF improvement. Purpose Evaluate prevalence, clinical characteristics and outcomes of patients in whom ejection fraction declined after previous improvement. Methods We retrospectively studied patients followed at a heart failure (HF) clinic with LVEF improvement after an initial diagnosis of HF with reduced ejection fraction (EF), which was defined as having an LVEF &gt;40% on follow-up. We then evaluated the presence of LVEF “relapse” in these patients – a decline in LVEF to &lt;50% or &lt;40%, in cases where it recovered to preserved EF or to mid-range EF, respectively. We analysed patient demographics, clinical parameters and outcomes and used logistic regression to assess the predictors of LVEF “relapse”. Results 98 patients were studied, 70 (71%) male, median age 69 (58–76) years. Fifty-four (55%) patients had recovered EF (&gt;50%) and in 44 (45%) it had improved to mid-range values. In 36 (37%) occurred LVEF “relapse”: in 10 (10%) patients to an EF 40–50% and in 88 (90%) to an EF&lt;40%. Ischemic cardiomyopathy and non-ischemic dilated cardiomyopathy were the main HF aetiologies (38% and 35%, respectively). During a median follow-up of 7 years, 39 (40%) patients had at least one HF hospitalization. Global mortality was 30%, with no significant statistical difference between the two groups. In univariate analysis, HF duration, type 2 diabetes mellitus (T2DM), left main or left anterior descending coronary (LAD) disease, valvular heart disease (VHD) and chronic kidney disease (CKD) predicted LVEF “relapse”. In multivariate analysis, T2DM, left main or LAD disease and VHD were the only predictors of LVEF “relapse” (Table). Conclusion In this group of patients, LVEF “relapse” after it had initially improved was frequent and was predicted by the presence of T2DM, left main or LAD disease and VHD. Despite improved systolic function, these patients remain at high risk, thus the need to maintain treatment. Funding Acknowledgement Type of funding source: None

scholarly journals 632 Diagnostic and prognostic performance of HFA-PEFF and H2FpEF scores in patients with cardiac amyloidosis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Daniela Tomasoni ◽  
Marco Merlo ◽  
Alberto Aimo ◽  
Aldostefano Porcari ◽  
Maria Grazia De Angelis ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cardiac Amyloidosis ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Prognostic Performance ◽  
Echocardiographic Parameters

Abstract Aims HFA-PEFF and H2FPEF scores were developed to aid the diagnosis of heart failure with preserved ejection fraction (HFpEF) and have been associated with outcomes. We aimed to investigate the diagnostic and prognostic significance of these scores in patients with a specific phenotype of HFpEF, cardiac amyloidosis (CA). Methods and results In a retrospective, double-centre, observational study we included 171 patients with either transthyretin (ATTR) (n = 89, 52%) or light-chain (AL) (n = 82, 48%) cardiac amyloidosis and preserved left ventricular ejection fraction (LVEF). Patients were divided into three groups according to HFA-PEFF score (low, 0–1; intermediate 2–4; high 5–6) and H2FPEF score (low, 0–1; intermediate 2–5; high 6–9). None of the patients had a HFA-PEFF score of 0 or 1 (n = 0, 0%); 57 (33.3%) patients had HFA-PEFF score 2–4 and the majority (n = 114, 66.7%) had a high HFA-PEFF score. Twenty-eight (16.4%), 104 (60.8%), 39 (22.8%) patients had low, intermediate, and high H2FPEF score, respectively. During a median follow-up of 14.5 (6.5–30.2) months after diagnosis, 61 (35.7%) patients died. Patients with a high HFA-PEFF score had higher mortality, compared to those with an intermediate score (47.4% vs. 12.3%, P &lt; 0.001). After adjustment for several clinical variables, including age, sex, comorbidities, natriuretic peptides, troponin levels and echocardiographic parameters, a high HFA-PEFF score was independently associated with mortality (HR: 3.75; 95% CI: 1.61–8.70; P = 0.005). H2FPEF score was not significantly associated with outcomes. Conclusions Our results suggest that a low HFA-PEFF score successfully rules out CA diagnosis, whereas some CA patients present a low H2FPEF score, potentially misleading the diagnosis. HFA-PEFF but not H2FPEF score was associated with outcome in patients with CA.

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