TY - JOUR
T1 - The prognostic impact of mechanical atrial dysfunction and atrial fibrillation in heart failure with preserved ejection fraction
AU - Weerts, Jerremy
AU - Barandiarán Aizpurua, Arantxa
AU - Henkens, Michiel T H M
AU - Lyon, Aurore
AU - van Mourik, Manouk J W
AU - van Gemert, Mathijs R A A
AU - Raafs, Anne
AU - Sanders-van Wijk, Sandra
AU - Bayés-Genís, Antoni
AU - Heymans, Stephane R B
AU - Crijns, Harry J G M
AU - Brunner-La Rocca, Hans-Peter
AU - Lumens, Joost
AU - van Empel, Vanessa P M
AU - Knackstedt, Christian
N1 - Funding Information:
This work was supported by the Dutch Heart Foundation (grant numbers CVON2017-21-SHE PREDICTS HF and CVON2015-10-Early HFpEF both to V.P.M.v.E. and S.R.B.H., as well as 2015T082 and 2018T094, both to J.L.); the Health Foundation Limburg to V.P.M.v.E.; and the Netherlands Organisation for Scientific Research (NWO-ZonMw, VIDI grant number 016.176.340) to J.L.
Publisher Copyright:
© 2021 The Author(s).
PY - 2022
Y1 - 2022
N2 - AIMS: This study assessed the prognostic implications of mechanical atrial dysfunction in heart failure with preserved ejection fraction (HFpEF) patients with different stages of atrial fibrillation (AF) in detail.METHODS AND RESULTS: HFpEF patients (n = 258) systemically underwent an extensive clinical characterization, including 24-h Holter monitoring and speckle-tracking echocardiography. Patients were categorized according to rhythm and stages of AF: 112 with no history of AF (no AF), 56 with paroxysmal AF (PAF), and 90 with sustained (persistent/permanent) AF (SAF). A progressive decrease in mechanical atrial function was seen: left atrial reservoir strain (LASr) 30.5 ± 10.5% (no AF), 22.3 ± 10.5% (PAF), and 13.9 ± 7.8% (SAF), P < 0.001. Independent predictors for lower LASr values were AF, absence of chronic obstructive pulmonary disease, higher N-terminal-pro hormone B-type natriuretic peptide, left atrial volume index, and relative wall thickness, lower left ventricular global longitudinal strain, and echocardiographic signs of elevated left ventricular filling pressure. LASr was an independent predictor of adverse outcome (hazard ratio per 1% decrease =1.049, 95% confidence interval 1.014-1.085, P = 0.006), whereas AF was not when the multivariable model included LASr. Moreover, LASr mediated the adverse outcome associated with AF in HFpEF (P = 0.008).CONCLUSION: Mechanical atrial dysfunction has a possible greater prognostic role in HFpEF compared to AF status alone. Mechanical atrial dysfunction is a predictor of adverse outcome independently of AF presence or stage, and may be an underlying mechanism (mediator) for the worse outcome associated with AF in HFpEF. This may suggest mechanical atrial dysfunction plays a crucial role in disease progression in HFpEF patients with AF, and possibly also in HFpEF patients without AF.
AB - AIMS: This study assessed the prognostic implications of mechanical atrial dysfunction in heart failure with preserved ejection fraction (HFpEF) patients with different stages of atrial fibrillation (AF) in detail.METHODS AND RESULTS: HFpEF patients (n = 258) systemically underwent an extensive clinical characterization, including 24-h Holter monitoring and speckle-tracking echocardiography. Patients were categorized according to rhythm and stages of AF: 112 with no history of AF (no AF), 56 with paroxysmal AF (PAF), and 90 with sustained (persistent/permanent) AF (SAF). A progressive decrease in mechanical atrial function was seen: left atrial reservoir strain (LASr) 30.5 ± 10.5% (no AF), 22.3 ± 10.5% (PAF), and 13.9 ± 7.8% (SAF), P < 0.001. Independent predictors for lower LASr values were AF, absence of chronic obstructive pulmonary disease, higher N-terminal-pro hormone B-type natriuretic peptide, left atrial volume index, and relative wall thickness, lower left ventricular global longitudinal strain, and echocardiographic signs of elevated left ventricular filling pressure. LASr was an independent predictor of adverse outcome (hazard ratio per 1% decrease =1.049, 95% confidence interval 1.014-1.085, P = 0.006), whereas AF was not when the multivariable model included LASr. Moreover, LASr mediated the adverse outcome associated with AF in HFpEF (P = 0.008).CONCLUSION: Mechanical atrial dysfunction has a possible greater prognostic role in HFpEF compared to AF status alone. Mechanical atrial dysfunction is a predictor of adverse outcome independently of AF presence or stage, and may be an underlying mechanism (mediator) for the worse outcome associated with AF in HFpEF. This may suggest mechanical atrial dysfunction plays a crucial role in disease progression in HFpEF patients with AF, and possibly also in HFpEF patients without AF.
KW - heart failure with preserved ejection fraction
KW - atrial fibrillation
KW - left atrium
KW - atrial failure
KW - strain imaging
KW - echocardiography
KW - UNDERLYING ATRIAL
KW - STRAIN-RATE
KW - ECHOCARDIOGRAPHY
KW - TRACKING
KW - RECOMMENDATIONS
KW - CONSENSUS
U2 - 10.1093/ehjci/jeab222
DO - 10.1093/ehjci/jeab222
M3 - Article
C2 - 34718457
SN - 2047-2404
VL - 23
SP - 74
EP - 84
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 1
ER -