Clinical and Echocardiographic Factors Associated With New-Onset Atrial Fibrillation in Heart Failure　– Subanalysis of the WARCEF Trial –

Kato, Tomoko S.; Tullio, Marco R. Di; Qian, Min; Wu, Mengfei; Thompson, John L.P.; Mann, Douglas L.; Sacco, Ralph L.; Pullicino, Patrick; Freudenberger, Ronald S; Teerlink, John R.; Graham, Susan; Lip, Gregory Y.H.; Levin, Bruce; Mohr, J. P.; Labovitz, Arthur J.; Estol, Conrado J.; Lok, Dirk J.; Ponikowski, Piotr; Anker, Stefan D.; Homma, Shunichi

doi:10.1253/circj.cj-15-1054

Cited by 11 publications

(9 citation statements)

References 35 publications

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“…Finally, we did not formally monitor for the occurrence of asymptomatic AF during the WARCEF study, although a small number of participants (∼10%) did develop clinical AF during the follow-up period. 18 Although this may have contributed to the relationship between the CHA 2 DS 2 -VASc score and clinical outcomes observed in our analysis, this does not change our finding that the CHA 2 DS 2 -VASc score represents a potentially useful tool for risk stratification in this patient population.…”

Section: Discussionmentioning

confidence: 64%

“…However, any such model would also need to be validated externally, while the CHA 2 DS 2 ‐VASc risk score is easy to calculate and already widely accepted, making it more likely to be clinically useful should future studies continue to confirm our findings. Finally, we did not formally monitor for the occurrence of asymptomatic AF during the WARCEF study, although a small number of participants (∼10%) did develop clinical AF during the follow‐up period . Although this may have contributed to the relationship between the CHA 2 DS 2 ‐VASc score and clinical outcomes observed in our analysis, this does not change our finding that the CHA 2 DS 2 ‐VASc score represents a potentially useful tool for risk stratification in this patient population.…”

Section: Discussionmentioning

confidence: 99%

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CHA₂DS₂‐VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm

Qian

Zhao

et al. 2016

European J of Heart Fail

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Aims To determine whether the CHA2DS2-VASc score can predict adverse outcomes such as death, ischemic stroke, and major hemorrhage, in patients with systolic heart failure in sinus rhythm. Methods and Results CHA2DS2-VASc scores were calculated for 1,101 patients randomized to warfarin and 1,123 patients randomized to aspirin. Adverse outcomes were defined as death or ischemic stroke, death alone, ischemic stroke alone, and major hemorrhage. Using proportional hazards models, we found that each 1-point increase in the CHA2DS2-VASc score was associated with increased hazard of death or ischemic stroke events (hazard ratio [HR] for the warfarin arm = 1.21 [1.13–1.30], p<0.001; for aspirin, HR = 1.20 [1.11–1.29], p<0.001). Similar increased hazards for higher CHA2DS2-VASc scores were observed for death alone, ischemic stroke alone, and major hemorrhage. Overall performance of the CHA2DS2-VASc score was assessed using c-statistics for full models containing the risk score, treatment assignment, and score-treatment interaction, with the c-statistics for the full models ranging from 0.57 for death to 0.68 for major hemorrhage. Conclusions The CHA2DS2-VASc score predicted adverse outcomes in patients with systolic HF in sinus rhythm, with modest prediction accuracy.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

CHA₂DS₂‐VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm

Qian

Zhao

et al. 2016

European J of Heart Fail

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“…Furthermore, obesity is associated with LVH and diastolic dysfunction, 14 and is a predictor of new onset AF, 15 although a recent paper showed no association of BMI with new onset AF in HF patients. 40 Accordingly, AF might have a stronger negative impact on hemodynamics in patients with diastolic dysfunction because of impaired blood filling of the LV chamber. Therefore, AF might have had a greater adverse clinical impact on obese patients, but, as shown in the present study, obese patients were more resistant to the unfavorable effects of AF.…”

Section: Impact Of Overweight/underweight On Afmentioning

confidence: 99%

Effect of Obesity on the Prognostic Impact of Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction

Yagawa

Nagatomo

Izumi

et al. 2017

Circ J

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Background: Although obesity is associated with left ventricular hypertrophy, diastolic dysfunction, and occurrence of atrial fibrillation (AF), obese heart failure (HF) patients have a more favorable clinical outcome (obesity paradox). The clinical impact of AF on obese or lean HF patients has not been fully elucidated. Methods and Results:We analyzed 1,681 patients who were enrolled in the West Tokyo Heart Failure Registry (WET-HF Registry), a multicenter, prospective cohort registry from 2005 through 2014. We assigned them to 3 categories based on body mass index (BMI): low, BMI <18.5; medium, BMI ≥18.5 and <25; and high, BMI ≥25 (n=182/915/400). The clinical endpoint was all-cause death or readmission for acute decompensated HF. During 406 days of follow-up (IQR, 116-739 days), AF was associated with a higher risk of the endpoint in the HF with preserved ejection fraction (HFpEF) group (P<0.001, log-rank test), but not in the HF with reduced EF (HFrEF) group. AF was associated with a higher risk of the endpoint in low and medium BMI patients with HFpEF (P=0.016 and 0.009, respectively). On Multivariate Cox proportional hazards analysis, AF was an independent predictor of the endpoint in patients with BMI <25 from the HFpEF group (hazard ratio, 1.74; 95% CI: 1.21-2.54, P=0.003), but not in the other subgroups.Conclusions: AF had a negative impact on clinical outcome in non-obese patients with HFpEF.

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“…Few studies have reported AF burden as a function of atrial size/volume in patients with HF. The risk of new onset AF or AF recurrence could have either positive or no association with baseline LA size/volume. The prevalence of AF history was greater in 4 th versus 1 st –3 rd quartiles of LA volume index in mildly symptomatic systolic HF patients (16% vs 10%, respectively, <0.001) .…”

Section: Is Af Occurrence Lower In Hf Patients With Severe Versus Modmentioning

confidence: 99%

Is extensive atrial fibrosis in the setting of heart failure associated with a reduced atrial fibrillation burden?

Burashnikov

Antzelevitch

2018

Pacing Clinical Electrophis

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Atrial fibrillation (AF) affects 10-50% of patients with chronic heart failure (HF) and is associated with poor long-term prognosis. AF is commonly associated with atrial structural remodeling (ASR), principally characterized by atrial dilatation and fibrosis. However, the occurrence of AF in the full spectrum of ASR encountered in patients with HF is poorly defined. Experimental studies have presented evidence that extensive ASR can be accompanied with a reduced burden of AF, secondary to a prominent depression of atrial excitability. This reduction in AF burden is associated with severe atrial fibrosis rather than with dilatation. Clinical studies of patients with HF point to the possibility that advanced ASR is associated with a less frequent AF occurrence than moderate ASR. Our goal in this review is to introduce the hypothesis that AF is less likely to occur in severe versus moderate atrial ASR in the setting of HF and that it is severe atrial fibrosis-associated depression of atrial excitability that reduces AF burden.

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Clinical and Echocardiographic Factors Associated With New-Onset Atrial Fibrillation in Heart Failure　– Subanalysis of the WARCEF Trial –

Cited by 11 publications

References 35 publications

CHA₂DS₂‐VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm

CHA₂DS₂‐VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm

Effect of Obesity on the Prognostic Impact of Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction

Is extensive atrial fibrosis in the setting of heart failure associated with a reduced atrial fibrillation burden?

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Clinical and Echocardiographic Factors Associated With New-Onset Atrial Fibrillation in Heart Failure – Subanalysis of the WARCEF Trial –

Cited by 11 publications

References 35 publications

CHA2DS2‐VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm

CHA2DS2‐VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm

Effect of Obesity on the Prognostic Impact of Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction

Is extensive atrial fibrosis in the setting of heart failure associated with a reduced atrial fibrillation burden?

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Product

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Clinical and Echocardiographic Factors Associated With New-Onset Atrial Fibrillation in Heart Failure　– Subanalysis of the WARCEF Trial –

CHA₂DS₂‐VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm

CHA₂DS₂‐VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm