Meta-Analysis of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Preserved Ejection Fraction

Liu, Gang; Long, Ming; Hu, Xun; Du, Zhimin

doi:10.1016/j.hlc.2020.10.010

Cited by 18 publications

(14 citation statements)

References 45 publications

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“…However, A retrospective study supported that AF was associated with increased all‐cause mortality in patients with HFpEF but not in patients with HFrEF 48 . Furthermore, a recently published meta‐analysis evaluating the relationship between AF and mortality risk in HFpEF, showed that AF was associated with an 11% increased risk of all‐cause mortality in patients with HFpEF and AF was an independent predictor of HF hospitalization, cardiovascular death, and stroke 49 . Future studies should focus on the underlying mechanisms of these dual conditions and seek potential therapeutic strategies.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and long‐term prognosis of patients with reduced, mid‐range, and preserved ejection fraction: A systemic review and meta‐analysis

Liang

Bian

Yang

2022

Clinical Cardiology

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Aims Patients with heart failure (HF) have a poor prognosis and are categorized by ejection fraction. We performed a meta‐analysis to compare baseline characteristics and long‐term outcomes of patients with heart failure with reduced (HFrEF), mid‐range (HFmrEF), and preserved ejection fraction (HFpEF). Methods and Results A total of 27 prospective studies were included. Patients with HFpEF were older and had a higher proportion of females, hypertension, diabetes, and insufficient neuroendocrine antagonist treatments, while patients with HFrEF and HFmrEF had a higher prevalence of coronary heart disease and chronic kidney disease. After more than 1‐year of follow‐up, all‐cause mortality was significantly lower in patients with HFmrEF 9388/25 042 (37.49%) than those with HFrEF 39 333/90 023 (43.69%) and HFpEF 24 828/52 492 (47.30%) (p < .001). Cardiovascular mortality was lowest in patients with HFpEF 1130/9904 (11.41%), highest in patients with HFrEF 3419/16 277 (21.07%) mainly coming from HF death and sudden cardiac death, and middle in patients with HFmrEF 699/5171 (13.52%) and the non‐cardiovascular mortality was on the contrary. Subgroup analysis showed that in high‐risk patients with atrial fibrillation, the all‐cause mortality of HFpEF was significantly higher than both HFrEF and HFmrEF (p < .001). HF hospitalization was lowest in patients with HFmrEF 1822/5285 (34.47%), highest in patients with HFrEF 12 607/28 590 (44.10%) and middle in patients with HFpEF 8686/22 763 (38.16%) and the composite of all‐cause mortality and HF hospitalization was also observed similar results. Conclusions In summary, patients with HFmrEF had the lowest incidence of all‐cause mortality and HF hospitalization, while the highest all‐cause mortality and HF hospitalization rates were HFpEF and HFrEF patients, respectively.

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Section: Discussionmentioning

confidence: 99%

Characteristics and long‐term prognosis of patients with reduced, mid‐range, and preserved ejection fraction: A systemic review and meta‐analysis

Liang

Bian

Yang

2022

Clinical Cardiology

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“…More likely, the two disorders share a common mechanistic substrate, which causes AF and HFpEF [ 26 , 27 ] and develop in parallel. A recent meta-analysis underlined that AF was associated with poor prognosis in HFpEF, although it is unclear whether AF is only a marker of more severe heart failure, or a cause of mortality in itself [ 28 ]. Atrial fibrillation is also an age-related marker, hence, it is not surprising that the prevalence of AF is higher in the older nondiabetic group.…”

Section: Discussionmentioning

confidence: 99%

Diabetic phenotype and prognosis of patients with heart failure and preserved ejection fraction in a real life cohort

Lejeune

Slimani

Pasquet

et al. 2021

Cardiovasc Diabetol

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Background Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome, with several underlying etiologic and pathophysiologic factors. The presence of diabetes might identify an important phenotype, with implications for therapeutic strategies. While diabetes is associated with worse prognosis in HFpEF, the prognostic impact of glycemic control is yet unknown. Hence, we investigated phenotypic differences between diabetic and non-diabetic HFpEF patients (pts), and the prognostic impact of glycated hemoglobin (HbA1C). Methods We prospectively enrolled 183 pts with HFpEF (78 ± 9 years, 38% men), including 70 (38%) diabetics (type 2 diabetes only). They underwent 2D echocardiography (n = 183), cardiac magnetic resonance (CMR) (n = 150), and were followed for a combined outcome of all-cause mortality and first HF hospitalization. The prognostic impact of diabetes and glycemic control were determined with Cox proportional hazard models, and illustrated by adjusted Kaplan Meier curves. Results Diabetic HFpEF pts were younger (76 ± 9 vs 80 ± 8 years, p = 0.002), more obese (BMI 31 ± 6 vs 27 ± 6 kg/m2, p = 0.001) and suffered more frequently from sleep apnea (18% vs 7%, p = 0.032). Atrial fibrillation, however, was more frequent in non-diabetic pts (69% vs 53%, p = 0.028). Although no echocardiographic difference could be detected, CMR analysis revealed a trend towards higher LV mass (66 ± 18 vs 71 ± 14 g/m2, p = 0.07) and higher levels of fibrosis (53% vs 36% of patients had ECV by T1 mapping > 33%, p = 0.05) in diabetic patients. Over 25 ± 12 months, 111 HFpEF pts (63%) reached the combined outcome (24 deaths and 87 HF hospitalizations). Diabetes was a significant predictor of mortality and hospitalization for heart failure (HR: 1.72 [1.1–2.6], p = 0.011, adjusted for age, BMI, NYHA class and renal function). In diabetic patients, lower levels of glycated hemoglobin (HbA1C < 7%) were associated with worse prognosis (HR: 2.07 [1.1–4.0], p = 0.028 adjusted for age, BMI, hemoglobin and NT-proBNP levels). Conclusion Our study highlights phenotypic features characterizing diabetic patients with HFpEF. Notably, they are younger and more obese than their non-diabetic counterpart, but suffer less from atrial fibrillation. Although diabetes is a predictor of poor outcome in HFpEF, intensive glycemic control (HbA1C < 7%) in diabetic patients is associated with worse prognosis.

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“…Numerous studies have shown that patients with HFpEF fare significantly worse when they have coexistent AF, and a recently published meta-analysis confirmed a significant increased risk of all-cause mortality, cardiovascular mortality, stroke, and heart failure hospitalizations. 96 Mortality is also increased in AF patients who develop incident HFpEF. 11 However, these data are based on the assumption that HFpEF is a discrete entity that patients with AF either have or do not have.…”

Section: Prognostic Implicationsmentioning

confidence: 99%

Heart failure with preserved ejection fraction: An alternative paradigm to explain the clinical implications of atrial fibrillation

et al. 2021

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Atrial fibrillation (AF) is associated with exercise intolerance, stroke, and all-cause mortality. However, whether this can be solely attributable to the arrhythmia itself or alternative mechanisms remains controversial. Heart failure with preserved ejection (HFpEF) commonly coexists with AF and may contribute to the poor outcomes associated with AF. Indeed, several invasive hemodynamic studies have confirmed that patients with AF are at increased risk of underlying HFpEF and that the presence of HFpEF may have important prognostic implications in these patients.Mechanistically, AF and HFpEF are closely linked. Both conditions are driven by the presence of common cardiovascular risk factors and are associated with left atrial (LA) myopathy, characterized by mechanical and electrical dysfunction. Progressive worsening of this left atrial (LA) myopathy is associated with both increased AF burden and worsening HFpEF. In addition, there is growing evidence to suggest that worsening LA myopathy is associated with poorer outcomes in both conditions and that reversal of the LA myopathy could improve outcomes. In this review article, we will present the epidemiologic and mechanistic evidence underlying the common coexistence of AF and HFpEF, discuss the importance of a progressive LA myopathy in the pathogenesis of both conditions, and review the evidence from important invasive hemodynamic studies. Finally, we will review the prognostic implications of HFpEF in patients with AF and discuss the relative merits of AF burden reduction vs HFpEF reduction in improving outcomes of patients with AF and HFpEF.

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Meta-Analysis of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Preserved Ejection Fraction

Cited by 18 publications

References 45 publications

Characteristics and long‐term prognosis of patients with reduced, mid‐range, and preserved ejection fraction: A systemic review and meta‐analysis

Characteristics and long‐term prognosis of patients with reduced, mid‐range, and preserved ejection fraction: A systemic review and meta‐analysis

Diabetic phenotype and prognosis of patients with heart failure and preserved ejection fraction in a real life cohort

Heart failure with preserved ejection fraction: An alternative paradigm to explain the clinical implications of atrial fibrillation

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