Prognostic significance of atrial fibrillation in acute decompensated heart failure with reduced versus preserved ejection fraction

Jobs, Alexander; Schwind, Julia; Katalinic, Alexander; Babaev, Valentin; Tilz, Roland Richard; Rausch, Stefan; Thiele, Holger; Eitel, Ingo; Eitel, Charlotte

doi:10.1007/s00392-018-1321-4

Cited by 19 publications

(7 citation statements)

References 41 publications

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“…In this study of HFpEF patients, as defined by contemporary cutoff values in ejection fraction, we have confirmed that PENK is a strong correlate of renal function, and provides prognosis for the composite outcome of death and/or HF hospitalisation. In these multivariable models, PENK emerged as a significant marker for death/HF, even following adjustment for clinical variables that have previously been reported as prognostic markers, such as AF [21] and anaemia [22]. PENK remained an independent marker for death/HF even following adjustment for troponin and Body Mass Index.…”

Section: Discussionmentioning

confidence: 87%

Proenkephalin and prognosis in heart failure with preserved ejection fraction: a GREAT network study

et al. 2019

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Background Proenkephalin (PENK), a stable endogenous opioid biomarker related to renal function, has prognostic utility in acute and chronic heart failure. We investigated the prognostic utility of PENK in heart failure with preserved ejection fraction (HFpEF), and its relationship to renal function, Body Mass Index (BMI), and imaging measures of diastolic dysfunction. Methods In this multicentre study, PENK was measured in 522 HFpEF patients (ejection fraction > 50%, 253 male, mean age 76.13 ± 10.73 years) and compared to 47 age and sex-matched controls. The primary endpoint was 2-years composite of all-cause mortality and/or heart failure rehospitalisation (HF). A subset ( n = 163) received detailed imaging studies. Results PENK levels were raised in HFpEF (median [interquartile range] 88.9 [62.1–132.0]) compared to normal controls (56.3 [47.9–70.5]). PENK was correlated to urea, eGFR, Body Mass Index and E / e ′ ( r s 0.635, − 0.741, − 0.275, 0.476, respectively, p < 0.0005). During 2 years follow-up 144 patients died and 220 had death/HF endpoints. Multivariable Cox regression models showed PENK independently predicted 2 year death/HF [hazard ratio (for 1 SD increment of log-transformed biomarker) HR 1.45 [95% CI 1.12–1.88, p = 0.005]], even after adjustment for troponin (HR 1.59 [1.14–2.20, p = 0.006]), and Body Mass Index (HR 1.63 [1.13–2.33, p = 0.009]). PENK showed no interaction with ejection fraction status for prediction of poor outcomes. Net reclassification analyses showed PENK significantly improved classification of death/HF outcomes for multivariable models containing natriuretic peptide, troponin and Body Mass Index ( p < 0.05 for all). Conclusions In HFpEF, PENK levels are related to BMI, and measures of diastolic dysfunction and are prognostic for all-cause mortality and heart failure rehospitalisation. Electronic supplementary material The online version of this article (10.1007/s00392-019-01424-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 87%

Proenkephalin and prognosis in heart failure with preserved ejection fraction: a GREAT network study

et al. 2019

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“…HFpEF in AF patients is associated with an increase in heart failure symptoms, higher hospitalization rates, morbidity, and mortality compared to AF alone, which is thought to be related to a more vulnerable hemodynamic state caused by left ventricular diastolic dysfunction 18,19 . Evaluation of hospitalization showed significantly lower event rates after CA, indicating that resolution of HFpEF may decrease morbidity.…”

Section: Discussionmentioning

confidence: 99%

Catheter ablation for atrial fibrillation in HFpEF patients—A propensity‐score‐matched analysis

Rattka

Kühberger

Pott

et al. 2021

Cardiovasc electrophysiol

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Background Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are both common conditions associated with high morbidity and mortality, especially if they coexist. Catheter ablation (CA) for AF has been shown recently to induce reverse remodeling and improve symptoms in HFpEF patients. The aim of this study was to compare outcomes of AF patients with HFpEF, who either underwent CA for AF or received medical therapy only. Methods and Results We included all AF patients with HFpEF according to current guidelines treated at our hospital between 2013 and 2018. Out of 6614 AF patients, we identified 127 with confirmed HFpEF. After applying propensity score matching to balance patient groups, 43 patients treated by CA and 43 patients receiving medical treatment were compared. Patients in the CA group underwent a mean of 1.5 ± 0.8 ablation procedures. Arrhythmia recurrence occurred significantly less frequently in the CA group (hazard ratio [HR]: 0.47; 95% CI: 0.25–0.87; p = .016). The primary endpoint, a composite of heart failure hospitalization and death, was reduced significantly by CA compared to medical therapy (HR: 0.30; 95% CI: 0.13–0.67; p = .003). This was driven by a decrease in heart failure hospitalization. Clinical and echocardiographic parameters of HFpEF improved significantly only after CA. Remarkably, reassessment of diagnostic HFpEF criteria at the end of follow‐up demonstrated HFpEF resolution in 15 out of 43 patients (35%) treated by CA and only 4 out of 43 patients (9%) treated medically (p = .008). Conclusion Catheter ablation for AF in HFpEF patients in comparison to medical therapy decreases heart failure hospitalization, heart failure symptoms, and improves diastolic function. AF ablation should be considered in patients with HFpEF and concomitant AF.

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“…Atrial fibrillation is often seen in patients with HFpEF and is associated with increased mortality 18,19 . Gaining insight in the pathophysiology of atrial fibrillation in HFpEF patients is therefore paramount.…”

Section: Discussionmentioning

confidence: 99%

Importance of epicardial adipose tissue localization using cardiac magnetic resonance imaging in patients with heart failure with mid‐range and preserved ejection fraction

Woerden

Veldhuisen

Gorter

et al. 2021

Clinical Cardiology

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Background Epicardial adipose tissue (EAT) has been implicated in the pathophysiology of heart failure (HF) with left ventricular ejection fraction (LVEF) >40%, but whether this is due to a regional or global effect of EAT remains unclear. Hypothesis Regional EAT is associated with alterations in local cardiac structure and function. Methods Patients with HF and LVEF >40% were studied. Cardiac Magnetic Resonance imaging was used to localize EAT surrounding the right ventricle (RV) and LV separately, using anterior‐ and posterior interventricular grooves as boundaries. Atrial‐ and ventricular EAT were differentiated using the mitral‐valve position. All EAT depots were related to the adjacent myocardial structure. Results 102 consecutive HF patients were enrolled. The majority of EAT was present around the RV (42% of total EAT, p < .001). RV‐EAT showed a strong association with increased RV mass (β = 0.60, p < .001) and remained associated with RV mass after adjusting for total EAT, sex, N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP), renal function and blood glucose. LV‐EAT showed a similar association with LV mass in univariable analysis, albeit less pronounced (β = 0.24, p = .02). Atrial EAT was increased in patients with atrial fibrillation compared to those without atrial fibrillation (30 vs. 26 ml/m2, p = .04), whereas ventricular EAT was similar (74 vs. 75 ml/m2, p = .9). Conclusions Regional EAT is strongly associated with local cardiac structure and function in HF patients with LVEF >40%. These data support the hypothesis that regional EAT is involved in the pathophysiology of HF with LVEF >40%.

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Prognostic significance of atrial fibrillation in acute decompensated heart failure with reduced versus preserved ejection fraction

Abstract: AF is common in the setting of ADHF and is associated with increased all-cause mortality. However, this association remained significant only in patients with HFpEF, but not in patients with HFrEF.

Cited by 19 publications

References 41 publications

Proenkephalin and prognosis in heart failure with preserved ejection fraction: a GREAT network study

Proenkephalin and prognosis in heart failure with preserved ejection fraction: a GREAT network study

Catheter ablation for atrial fibrillation in HFpEF patients—A propensity‐score‐matched analysis

Importance of epicardial adipose tissue localization using cardiac magnetic resonance imaging in patients with heart failure with mid‐range and preserved ejection fraction

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