Inter-atrial block as a predictor of adverse outcomes in patients with HFpEF

Jerremy Weerts; Sanne G. J. Mourmans; Helena Lopez-Martinez; Mar Domingo; Arantxa Barandiaran Aizpurua; Michiel T. H. M. Henkens; Anouk Achten; Josep Lupon; Hans-Peter Brunner-La Rocca; Christian Knackstedt; Antoni Bayes-Genis; Vanessa P. M. van Empel

doi:10.1002/ehf2.15179

Inter-atrial block as a predictor of adverse outcomes in patients with HFpEF

Jerremy Weerts^*, Sanne G. J. Mourmans^*, Helena Lopez-Martinez, Mar Domingo, Arantxa Barandiaran Aizpurua, Michiel T. H. M. Henkens, Anouk Achten, Josep Lupon, Hans-Peter Brunner-La Rocca, Christian Knackstedt, Antoni Bayes-Genis, Vanessa P. M. van Empel

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Aims: Inter-atrial block (IAB), a marker of electrical atrial dysfunction, is associated with an increased risk of atrial fibrillation (AF) and adverse events in various populations. The prognostic impact of IAB in heart failure (HF) with preserved ejection fraction (HFpEF) remains unknown. The aim of this study is to determine the prevalence of IAB and the association of IAB and AF with adverse events in HFpEF across different healthcare settings. Methods and results: To identify electrical atrial dysfunction, baseline ECG's and medical history were analysed in HFpEF patients in an ambulatory setting and after recent HF hospitalisation. Patients were categorised into (i) HFpEF _{No IAB}, (ii) HFpEF _IAB, or (iii) HFpEF _AF. Adverse events included HF hospitalisation, cardiac/sudden death and a composite of both. The ambulatory cohort included 372 patients [mean age 75 ± 7 years, 252 (68%) females]. The recently hospitalised cohort included 132 patients [mean age 81 ± 10 years, 80 (61%) females]. Ambulatory patients included 17 (4%) HFpEF _noIAB, 114 (31%) HFpEF _IAB and 241 (65%) HFpEF _AF, while recently hospitalised patients included 31 (23%), 73 (55%) and 28 (21%), respectively. After 33 months of follow-up of ambulatory patients, composite endpoints occurred in 0 (0%) HFpEF _noIAB, 12 (11%) HFpEF _IAB [HR 4.1 (95% CI 0.5–522.6)] and 59 (24%) HFpEF _AF patients [HR 10.1 (95% CI 1.5–1270.4), P < 0.001]. Recently hospitalised patients showed a similar trend, with composite endpoints in 10 (32%) HFpEF _noIAB, 31 (42%) HFpEF _IAB (HR 1.5 [95% CI 0.7–3.1]) and 22 (79%) HFpEF _AF (HR 3.8 [95% CI 1.8–8.1], P < 0.001). Conclusions: Progressive stages of electrical atrial dysfunction appeared to be prognostic markers of adverse outcomes in ambulatory and recently hospitalised patients with HFpEF. Ambulatory patients with HFpEF and no early stages of electrical atrial dysfunction showed to be at very low risk for adverse outcomes. Whether such patients benefit less strict management remains to be investigated.

Original language	English
Pages (from-to)	2287-2297
Number of pages	11
Journal	Esc heart failure
Volume	12
Issue number	3
Early online date	1 Dec 2024
DOIs	https://doi.org/10.1002/ehf2.15179
Publication status	E-pub ahead of print - 1 Dec 2024

Keywords

Atrial dysfunction
Atrial fibrillation
Electrocardiography
Heart atria
Heart failure with preserved ejection fraction
Prognosis
PRESERVED EJECTION FRACTION
HEART-FAILURE
ATRIAL-FIBRILLATION
PREVALENCE
DYSFUNCTION

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Weerts, J., Mourmans, S. G. J., Lopez-Martinez, H., Domingo, M., Aizpurua, A. B., Henkens, M. T. H. M., Achten, A., Lupon, J., Brunner-La Rocca, H.-P., Knackstedt, C., Bayes-Genis, A., & van Empel, V. P. M. (2025). Inter-atrial block as a predictor of adverse outcomes in patients with HFpEF. Esc heart failure, 12(3), 2287-2297. Advance online publication. https://doi.org/10.1002/ehf2.15179

@article{71d1302958874a7992661214637999f8,

title = "Inter-atrial block as a predictor of adverse outcomes in patients with HFpEF",

abstract = "Aims: Inter-atrial block (IAB), a marker of electrical atrial dysfunction, is associated with an increased risk of atrial fibrillation (AF) and adverse events in various populations. The prognostic impact of IAB in heart failure (HF) with preserved ejection fraction (HFpEF) remains unknown. The aim of this study is to determine the prevalence of IAB and the association of IAB and AF with adverse events in HFpEF across different healthcare settings. Methods and results: To identify electrical atrial dysfunction, baseline ECG's and medical history were analysed in HFpEF patients in an ambulatory setting and after recent HF hospitalisation. Patients were categorised into (i) HFpEF No IAB, (ii) HFpEF IAB, or (iii) HFpEF AF. Adverse events included HF hospitalisation, cardiac/sudden death and a composite of both. The ambulatory cohort included 372 patients [mean age 75 ± 7 years, 252 (68%) females]. The recently hospitalised cohort included 132 patients [mean age 81 ± 10 years, 80 (61%) females]. Ambulatory patients included 17 (4%) HFpEF noIAB, 114 (31%) HFpEF IAB and 241 (65%) HFpEF AF, while recently hospitalised patients included 31 (23%), 73 (55%) and 28 (21%), respectively. After 33 months of follow-up of ambulatory patients, composite endpoints occurred in 0 (0%) HFpEF noIAB, 12 (11%) HFpEF IAB [HR 4.1 (95% CI 0.5–522.6)] and 59 (24%) HFpEF AF patients [HR 10.1 (95% CI 1.5–1270.4), P < 0.001]. Recently hospitalised patients showed a similar trend, with composite endpoints in 10 (32%) HFpEF noIAB, 31 (42%) HFpEF IAB (HR 1.5 [95% CI 0.7–3.1]) and 22 (79%) HFpEF AF (HR 3.8 [95% CI 1.8–8.1], P < 0.001). Conclusions: Progressive stages of electrical atrial dysfunction appeared to be prognostic markers of adverse outcomes in ambulatory and recently hospitalised patients with HFpEF. Ambulatory patients with HFpEF and no early stages of electrical atrial dysfunction showed to be at very low risk for adverse outcomes. Whether such patients benefit less strict management remains to be investigated.",

keywords = "Atrial dysfunction, Atrial fibrillation, Electrocardiography, Heart atria, Heart failure with preserved ejection fraction, Prognosis, PRESERVED EJECTION FRACTION, HEART-FAILURE, ATRIAL-FIBRILLATION, PREVALENCE, DYSFUNCTION",

author = "Jerremy Weerts and Mourmans, {Sanne G. J.} and Helena Lopez-Martinez and Mar Domingo and Aizpurua, {Arantxa Barandiaran} and Henkens, {Michiel T. H. M.} and Anouk Achten and Josep Lupon and {Brunner-La Rocca}, Hans-Peter and Christian Knackstedt and Antoni Bayes-Genis and {van Empel}, {Vanessa P. M.}",

year = "2024",

month = dec,

day = "1",

doi = "10.1002/ehf2.15179",

language = "English",

volume = "12",

pages = "2287--2297",

journal = "Esc heart failure",

issn = "2055-5822",

publisher = "John Wiley & Sons Inc.",

number = "3",

}

TY - JOUR

T1 - Inter-atrial block as a predictor of adverse outcomes in patients with HFpEF

AU - Weerts, Jerremy

AU - Mourmans, Sanne G. J.

AU - Lopez-Martinez, Helena

AU - Domingo, Mar

AU - Aizpurua, Arantxa Barandiaran

AU - Henkens, Michiel T. H. M.

AU - Achten, Anouk

AU - Lupon, Josep

AU - Brunner-La Rocca, Hans-Peter

AU - Knackstedt, Christian

AU - Bayes-Genis, Antoni

AU - van Empel, Vanessa P. M.

PY - 2024/12/1

Y1 - 2024/12/1

N2 - Aims: Inter-atrial block (IAB), a marker of electrical atrial dysfunction, is associated with an increased risk of atrial fibrillation (AF) and adverse events in various populations. The prognostic impact of IAB in heart failure (HF) with preserved ejection fraction (HFpEF) remains unknown. The aim of this study is to determine the prevalence of IAB and the association of IAB and AF with adverse events in HFpEF across different healthcare settings. Methods and results: To identify electrical atrial dysfunction, baseline ECG's and medical history were analysed in HFpEF patients in an ambulatory setting and after recent HF hospitalisation. Patients were categorised into (i) HFpEF No IAB, (ii) HFpEF IAB, or (iii) HFpEF AF. Adverse events included HF hospitalisation, cardiac/sudden death and a composite of both. The ambulatory cohort included 372 patients [mean age 75 ± 7 years, 252 (68%) females]. The recently hospitalised cohort included 132 patients [mean age 81 ± 10 years, 80 (61%) females]. Ambulatory patients included 17 (4%) HFpEF noIAB, 114 (31%) HFpEF IAB and 241 (65%) HFpEF AF, while recently hospitalised patients included 31 (23%), 73 (55%) and 28 (21%), respectively. After 33 months of follow-up of ambulatory patients, composite endpoints occurred in 0 (0%) HFpEF noIAB, 12 (11%) HFpEF IAB [HR 4.1 (95% CI 0.5–522.6)] and 59 (24%) HFpEF AF patients [HR 10.1 (95% CI 1.5–1270.4), P < 0.001]. Recently hospitalised patients showed a similar trend, with composite endpoints in 10 (32%) HFpEF noIAB, 31 (42%) HFpEF IAB (HR 1.5 [95% CI 0.7–3.1]) and 22 (79%) HFpEF AF (HR 3.8 [95% CI 1.8–8.1], P < 0.001). Conclusions: Progressive stages of electrical atrial dysfunction appeared to be prognostic markers of adverse outcomes in ambulatory and recently hospitalised patients with HFpEF. Ambulatory patients with HFpEF and no early stages of electrical atrial dysfunction showed to be at very low risk for adverse outcomes. Whether such patients benefit less strict management remains to be investigated.

AB - Aims: Inter-atrial block (IAB), a marker of electrical atrial dysfunction, is associated with an increased risk of atrial fibrillation (AF) and adverse events in various populations. The prognostic impact of IAB in heart failure (HF) with preserved ejection fraction (HFpEF) remains unknown. The aim of this study is to determine the prevalence of IAB and the association of IAB and AF with adverse events in HFpEF across different healthcare settings. Methods and results: To identify electrical atrial dysfunction, baseline ECG's and medical history were analysed in HFpEF patients in an ambulatory setting and after recent HF hospitalisation. Patients were categorised into (i) HFpEF No IAB, (ii) HFpEF IAB, or (iii) HFpEF AF. Adverse events included HF hospitalisation, cardiac/sudden death and a composite of both. The ambulatory cohort included 372 patients [mean age 75 ± 7 years, 252 (68%) females]. The recently hospitalised cohort included 132 patients [mean age 81 ± 10 years, 80 (61%) females]. Ambulatory patients included 17 (4%) HFpEF noIAB, 114 (31%) HFpEF IAB and 241 (65%) HFpEF AF, while recently hospitalised patients included 31 (23%), 73 (55%) and 28 (21%), respectively. After 33 months of follow-up of ambulatory patients, composite endpoints occurred in 0 (0%) HFpEF noIAB, 12 (11%) HFpEF IAB [HR 4.1 (95% CI 0.5–522.6)] and 59 (24%) HFpEF AF patients [HR 10.1 (95% CI 1.5–1270.4), P < 0.001]. Recently hospitalised patients showed a similar trend, with composite endpoints in 10 (32%) HFpEF noIAB, 31 (42%) HFpEF IAB (HR 1.5 [95% CI 0.7–3.1]) and 22 (79%) HFpEF AF (HR 3.8 [95% CI 1.8–8.1], P < 0.001). Conclusions: Progressive stages of electrical atrial dysfunction appeared to be prognostic markers of adverse outcomes in ambulatory and recently hospitalised patients with HFpEF. Ambulatory patients with HFpEF and no early stages of electrical atrial dysfunction showed to be at very low risk for adverse outcomes. Whether such patients benefit less strict management remains to be investigated.

KW - Atrial dysfunction

KW - Atrial fibrillation

KW - Electrocardiography

KW - Heart atria

KW - Heart failure with preserved ejection fraction

KW - Prognosis

KW - PRESERVED EJECTION FRACTION

KW - HEART-FAILURE

KW - ATRIAL-FIBRILLATION

KW - PREVALENCE

KW - DYSFUNCTION

U2 - 10.1002/ehf2.15179

DO - 10.1002/ehf2.15179

M3 - Article

SN - 2055-5822

VL - 12

SP - 2287

EP - 2297

JO - Esc heart failure

JF - Esc heart failure

IS - 3

ER -

Inter-atrial block as a predictor of adverse outcomes in patients with HFpEF

Abstract

Keywords

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