No abstract

Objectives of this study were (1) to evaluate preoperative predictors of systolic and diastolic heart failure in patients undergoing liver transplantation (LT) and (2) to describe the prognostic implications of systolic and diastolic heart failure in these patients. The onset of heart failure after orthotopic LT remains poorly understood. Data were obtained for all LT recipients between January 2000 and December 2010. The primary outcome was post-LT heart failure: systolic (ejection fraction 50%), diastolic, or mixed heart failure. Patients underwent echocardiographic evaluation before and after LT. Pretransplant variables were evaluated as predictors of heart failure with Cox proportional hazards model. 970 LT recipients were followed for 5.3 6 3.4 years. Ninety-eight patients (10.1%) developed heart failure in the posttransplant period. There were 67 systolic (6.9%), 24 diastolic (2.5%), and 7 mixed systolic/diastolic (0.7%) heart failures. Etiology was ischemic in 18 (18.4%), tachycardia-induced in 8 (8.2%), valvular in 7 (7.1%), alcohol-related in 4 (4.1%), hypertensive heart disease in 3 (3.1%), and nonischemic in majority of patients (59.2%). Pretransplant grade 3 diastolic dysfunction, diabetes, hypertension, mean arterial pressure 65 mm Hg, mean pulmonary artery pressure 30 mm Hg, mean pulmonary capillary wedge pressure 15 mm Hg, hemodialysis, brain natriuretic peptide level and QT interval > 450 ms were found to be predictive for the development of new-onset systolic heart failure. However beta-blocker use before LT and tacrolimus after LT were associated with reduced development of new-onset systolic heart failure. In conclusion, pretransplant risk factors, hemodynamic variables, and echocardiographic variables are important predictors of post-LT heart failure. In patients undergoing LT, postoperative onset of systolic or diastolic heart failure was found to be an independent predictor of mortality.

A trial fibrillation (AF) is the most common sustained cardiac arrhythmia, currently affecting >2 million people in the United States. 1 With an aging population, its prevalence is projected to double over the next 30 years. 2,3 The total health expenditures incurred by patients with AF are almost 5 times those of patients without AF, ranging between $6 and $26 billion.4 AF is also associated with considerable morbidity and mortality. 5 Although the management of AF has received much attention, literature furthering our understanding of AF prevention remains limited. Editorial see p 1821 Clinical Perspective on p 1834Several studies have suggested an association between lifetime physical activity and the development of AF. 6,7 However, these studies used self-reported physical activity as a measure of physical function, which is not a direct measure of underlying physiology. The impact of cardiorespiratory fitness (CRF) on risk of AF has not been examined previously in large, multiracial cohort. In addition, it is not known if this relationship is influenced by incident coronary artery disease or incident left ventricular dysfunction, and the interactions between modifiable risk factors of AF (including obesity, hypertension, diabetes mellitus, smoking, and hyperlipidemia) and CRF and incident AF are also not well established.Background-Poor cardiorespiratory fitness (CRF) is an independent risk factor for cardiovascular morbidity and mortality.However, the relationship between CRF and atrial fibrillation (AF) is less clear. The aim of this analysis was to investigate the association between CRF and incident AF in a large, multiracial cohort that underwent graded exercise treadmill testing. Methods and Results-From 1991 to 2009, a total of 64 561 adults (mean age, 54.5±12.7 years; 46% female; 64% white) without AF underwent exercise treadmill testing at a tertiary care center. Baseline demographic and clinical variables were collected. Incident AF was ascertained by use of International Classification of Diseases, Ninth Revision code 427.31 and confirmed by linkage to medical claim files. Nested, multivariable Cox proportional hazards models were used to estimate the independent association of CRF with incident AF. During a median follow-up of 5.4 years (interquartile range, 3-9 years), 4616 new cases of AF were diagnosed. After adjustment for potential confounders, 1 higher metabolic equivalent achieved during treadmill testing was associated with a 7% lower risk of incident AF (hazard ratio, 0.93; 95% confidence interval, 0.92-0.94; P<0.001). This relationship remained significant after adjustment for incident coronary artery disease (hazard ratio, 0.92; 95% confidence interval, 0.91-0.93; P<0.001). The magnitude of the inverse association between CRF and incident AF was greater among obese compared with nonobese individuals (P for interaction=0.02). Conclusions Methods Study Population and SettingsThe methods of the Henry Ford Exercise Testing (FIT) Project have been published previously. 8 In short, the FIT...