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Che J, Song J, Long Y, Wang C, Zheng C, Zhou R, Liu Z. Association Between the Neutrophil-Lymphocyte Ratio and Prognosis of Patients Admitted to the Intensive Care Unit With Chronic Heart Failure: A Retrospective Cohort Study. Angiology 2024; 75:786-795. [PMID: 37586709 DOI: 10.1177/00033197231196174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The present study aimed to explore the association between the neutrophil-to-lymphocyte ratio (NLR) and prognosis of critically ill chronic heart failure patients. The records of 5298 patients who met the inclusion criteria were extracted from the Medical Information Mart for Intensive Care IV database. The primary outcome was 30-days all-cause mortality and the secondary outcome was 90-days all-cause mortality. Multivariable logistic regression analysis was performed to examine the relationship between NLR and 30-days mortality. Subgroup analysis was carried out to identify whether the association between NLR and 30-days mortality differed across various subgroups. For 30-days mortality, after adjusting for multiple confounders, the odds ratio (OR) (95% confidence interval [CI]) for the second (NLR 4.0-8.4) and the third (NLR ≥8.4) tertiles were 1.52 (1.13-2.03) and 2.53 (1.92-3.34), respectively, compared with the first tertile (NLR <4.0). As for 90-days mortality, the OR for the second (NLR 4.0-8.4) was 1.34 (1.07-1.67) and 2.23 (1.81-2.76) for the third (NLR ≥8.4) tertiles compared with the reference (NLR<4.0). The interactions between the sepsis subgroup and 30-days mortality were significant. Our study concluded that the NLR was an independent predictor of 30- and 90-days mortality for critically ill patients with chronic heart failure.
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Affiliation(s)
- Jinhang Che
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaqi Song
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxiang Long
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunping Wang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Caiyin Zheng
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruoyu Zhou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zengzhang Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Zeitler EP, Johnson AE, Cooper LB, Steinberg BA, Houston BA. Atrial Fibrillation and Heart Failure With Reduced Ejection Fraction: New Assessment of an Old Problem. JACC. HEART FAILURE 2024:S2213-1779(24)00516-X. [PMID: 39152985 DOI: 10.1016/j.jchf.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 08/19/2024]
Abstract
Atrial fibrillation (AF) and heart failure (HF)-specifically, heart failure with reduced ejection fraction (HFrEF)-often coexist, and each contributes to the propagation of the other. This relationship extends from the mechanistic and physiological to clinical syndromes, quality of life, and long-term cardiovascular outcomes. The risk factors for AF and HF overlap and create a critical opportunity to prevent adverse outcomes among patients at greatest risk for either condition. Increasing recognition of the linkages between AF and HF have led to widespread interest in designing diagnostic, predictive, and interventional strategies targeting all aspects of disease, from identifying genetic predisposition to addressing social determinants of health. Advances across this spectrum culminated in updated multisociety guidelines for management of AF, which includes specific consideration of comorbid AF and HF. This review expands on these guidelines by further highlighting relevant clinical trial findings and providing additional context for the evolving recommendations for management in this important and growing population.
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Affiliation(s)
- Emily P Zeitler
- Section of Cardiovascular Medicine, Dartmouth Health and The Dartmouth Institute, Lebanon New Hampshire, USA.
| | - Amber E Johnson
- Section of Cardiology, Department of Medicine, Pritzker School of Medicine of the University of Chicago, Chicago, Illinois, USA
| | - Lauren B Cooper
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York, USA
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Brian A Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Wattanachayakul P, Suenghataiphorn T, Srikulmontri T, Rujirachun P, Malin J, Danpanichkul P, Polpichai N, Saowapa S, Casipit BA, Amanullah A. Impact of COVID-19 infection on the in-hospital outcome of patients hospitalized for heart failure with comorbid atrial fibrillation: Insight from the National Inpatient Sample (NIS) database 2020. J Arrhythm 2024; 40:895-902. [PMID: 39139900 PMCID: PMC11317655 DOI: 10.1002/joa3.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/14/2024] [Accepted: 05/06/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction Atrial fibrillation (AF) and heart failure (HF) commonly coexist, resulting in adverse health and economic consequences such as declining ventricular function, heightened mortality, and reduced quality of life. However, limited information exists on the impact of COVID-19 on AF patients that hospitalized for HF. Methods We analyzed the 2020 U.S. National Inpatient Sample to investigate the effects of COVID-19 on AF patients that primarily hospitalized for HF. Participants aged 18 and above were identified using relevant ICD-10 CM codes. Adjusted odds ratios for outcomes were calculated through multivariable logistic regression. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications. Results We identified 322,090 patients with primary discharge diagnosis of HF with comorbid AF. Among them, 0.73% (2355/322,090) also had a concurrent diagnosis of COVID-19. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 3.17; 95% CI 2.25, 4.47, p < 0.001), prolonged length of stay (β LOS 2.82; 95% CI 1.71, 3.93, p < 0.001), acute myocarditis (aOR 6.64; 95% CI 1.45, 30.45, p 0.015), acute kidney injury (AKI) (aOR 1.48; 95% CI 1.21, 1.82, p < 0.001), acute respiratory failure (aOR 1.24; 95% CI 1.01, 1.52, p 0.045), and mechanical ventilation (aOR 2.00; 95% CI 1.28, 3.13, p 0.002). Conclusion Our study revealed that COVID-19 is linked to higher in-hospital mortality and increased adverse outcomes in AF patients hospitalized for HF.
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Affiliation(s)
- Phuuwadith Wattanachayakul
- Department of Medicine, Jefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | | | | | | | - John Malin
- Department of Medicine, Jefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | | | | | | | - Bruce A. Casipit
- Department of Medicine, Jefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Aman Amanullah
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
- Division of Cardiovascular DiseaseJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
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Bergau L. [Atrial fibrillation and heart failure]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:755-761. [PMID: 39007960 DOI: 10.1007/s00108-024-01743-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/16/2024]
Abstract
Atrial fibrillation and heart failure are among the most common cardiovascular diseases and have a significant impact on the mortality and morbidity of affected patients. From a pathophysiological perspective, the two diseases are closely related and often perpetuate each other. Therefore, effective management of atrial fibrillation is now a central component of modern heart failure treatment. Based on current data, sinus rhythm should primarily be permanently maintained in patients with systolic heart failure. Catheter ablation has recently proven to be advantageous over purely pharmacological therapy and is therefore the treatment of choice for many patients with heart failure and atrial fibrillation. In patients with diastolic heart failure (heart failure with preserved ejection fraction [HFpEF]), the effect of catheter ablation is less clear. Data from randomized studies are urgently needed in order to further assess efficacy in this population.
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Affiliation(s)
- Leonard Bergau
- Abteilung für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
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Ardashev A, Passman R, Zotova I, Efimov I, Rytkin E, Trachiotis G, Knight BP. Comprehensive Analysis of Anticoagulant Therapy in Patients With Isolated Atrial Flutter. Am J Cardiol 2024:S0002-9149(24)00569-1. [PMID: 39089525 DOI: 10.1016/j.amjcard.2024.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/10/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
Limited comparative data exist regarding the risk of cardiogenic emboli in patients with isolated atrial flutter (AFL). Some studies suggest a lower complication risk in AFL than atrial fibrillation (Afib); however, methodologic limitations and conflicting reports necessitate a comprehensive investigation. Our analysis proposes that isolated AFL carries a lower risk of ischemic events and left atrial thrombus formation than AFib. Importantly, we caution against applying stroke risk assessment approaches designed for AFib to patients with AFL because it may lead to harmful overestimations and unnecessary anticoagulant prescriptions. Furthermore, we highlight the current lack of sufficient data to determine the overall clinical benefit of prolonged anticoagulant therapy in patients with isolated AFL, especially when CHA2DS2-VASc index values are below 4. This review challenges existing perceptions, offering insights into the nuanced risk profiles of the transitional nature of isolated AFL because of the high incidence of AFib development within a year of AFL diagnosis. Tailored risk assessments and further research are essential for precise clinical decision-making in this dynamic landscape.
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Affiliation(s)
- Andrey Ardashev
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Rod Passman
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Irina Zotova
- Healthcare Department, State Budget Healthcare Institution "City Hospital #17" of Moscow, Moscow, Russian Federation
| | - Igor Efimov
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
| | - Eric Rytkin
- Department of Biomedical Engineering, Northwestern University, Chicago, Illinois
| | - Gregory Trachiotis
- Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia; Department of Surgery, the George Washington University Hospital, Washington, District of Columbia; Department of Biomedical Engineering, The George Washington University, Washington, District of Columbia
| | - Bradley P Knight
- Division of Cardiology, Northwestern University, Chicago, Illinois
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Chen X, Zhang X, Fang X, Feng S. Efficacy and safety of catheter ablation for atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1423147. [PMID: 39119189 PMCID: PMC11306038 DOI: 10.3389/fcvm.2024.1423147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024] Open
Abstract
Background Catheter ablation (CA) effectively treats atrial fibrillation (AF) in heart failure (HF) with reduced ejection fraction (HFrEF), improving clinical outcomes. However, its benefits for AF patients with heart failure with preserved ejection fraction (HFpEF) are still unclear. Methods We systematically searched PubMed, Embase, Web of Science, the Cochrane Library, and Scopus for studies investigating outcomes of CA in AF patients with HFpEF. Efficacy indicators included freedom from AF and antiarrhythmic drugs (AAD) free AF elimination. Safety indicators comprised total complications, HF admission, all-cause admission, and all-cause mortality. Sixteen studies with 20,796 patients included in our research. Results The comprehensive analysis demonstrated that, when comparing CA with medical therapy in HFpEF, no significant differences were observed in terms of HF admissions, all-cause admissions, and all-cause mortality [(OR: 0.42; 95% CI: 0.12-1.51, P = 0.19), (HR: 0.78; 95% CI: 0.48-1.27, P = 0.31), and (OR: 1.10; 95% CI: 0.83-1.44, P = 0.51)], while freedom from AF was significantly higher in CA (OR: 5.88; 95% CI: 2.99-11.54, P < 0.00001). Compared with HFrEF, CA in HFpEF showed similar rates of freedom from AF, AAD-free AF elimination, total complications, and all-cause admission were similar [(OR:0.91; 95% CI: 0.71,1.17, P =0.47), (OR: 0.97; 95% CI: 0.50-1.86, P = 0.93), (OR: 1.27; 95% CI: 0.47-3.41, P = 0.64), (OR: 1.11; 95% CI: 0.72, 1.73; P = 0.63)]. However, CA in HFpEF was associated with lower rates of HF admission and all-cause mortality [(OR: 0.35; 95% CI: 0.20, 0.60; P = 0.0002), (OR: 0.40; 95% CI: 0.18, 0.85; P = 0.02)]. Compared with patients without HF, CA in HFpEF patients exhibited lower rates of AAD-free AF elimination (OR: 0.48; 95% CI: 0.30, 0.75; P = 0.001). However, their rates of freedom from AF and total complications were similar [(OR: 0.70; 95% CI: 0.48, 1.02; P = 0.06), (OR: 0.60; 95% CI: 0.19, 1.90; P = 0.38)]. Conclusion This meta-analysis conducted provided a comprehensive evaluation of the efficacy and safety of CA in patients with AF and HFpEF. The results suggest that CA may represent a valuable treatment strategy for patients with AF and HFpEF. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier (CRD42024514169).
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Affiliation(s)
- Xiaomei Chen
- Department of Cardiology, Dazhou Second People’s Hospital, Dazhou, China
| | - Xuge Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Dazhou Second People’s Hospital, Dazhou, China
| | - Xiang Fang
- Department of Cardiology, Dazhou Second People’s Hospital, Dazhou, China
| | - Shenghong Feng
- Department of Cardiology, Dazhou Second People’s Hospital, Dazhou, China
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Zandijk AJL, Boorsma EM, Maaten JMT, Rienstra M, Voors AA. Characteristics and Clinical Outcomes of Patients Hospitalized for Acute Heart Failure Who Develop Atrial Fibrillation or Convert to Sinus Rhythm. J Card Fail 2024:S1071-9164(24)00233-1. [PMID: 39029616 DOI: 10.1016/j.cardfail.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia in acute heart failure (AHF), with a prevalence of approximately 35%. However, little is known about the clinical characteristics and outcomes of in-hospital conversion from AF to sinus rhythm and vice versa. METHODS In a post hoc secondary analysis of the randomized, double-blind, placebo-controlled PROTECT trial in patients with AHF, we identified 4 groups of patients: AF at admission and in-hospital conversion to sinus rhythm (n = 44); in-hospital development of AF (n = 31); persistent AF (n = 278); and continuous sinus rhythm (n = 410). RESULTS Conversion from AF to sinus rhythm (13.7%) and from sinus rhythm to AF (7.0%) occurred only in a minority of patients. Patients with AF who converted to sinus rhythm were more often classified as being in New York Heart Association class IV, had higher heart rates and higher respiratory rates at hospital admission, whereas patients who developed AF were older, more likely to be female and had the highest ejection fractions compared to continuous sinus rhythm (all P < 0.05). Conversion to sinus rhythm or development of AF occurred mainly within the first 24 hours after hospital admission. Patients with persistent AF and those who developed AF had longer median lengths of hospital stay (8 vs 7 days; P < 0.001 and 9 vs 7 days; P < 0.001, respectively), compared to those with continuous sinus rhythm. In both univariable and multivariable analyses, there was no significant association between the AF groups and the primary clinical outcomes of either 180-day all-cause mortality or 60-day death or readmission for heart failure. CONCLUSION In patients hospitalized for AHF, only few converted from AF to sinus rhythm or sinus rhythm to AF. Although development of AF or persistent AF was associated with longer lengths of hospitalization, midterm mortality and readmission rates were similar in the groups.
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Affiliation(s)
- Arietje J L Zandijk
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva M Boorsma
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jozine M Ter Maaten
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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8
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Sakai T, Tsuboi K, Takarada S, Okabe M, Nakaoka H, Ibuki K, Ozawa SW, Hata Y, Ichimata S, Nishida N, Hirono K. Tachycardia-Induced Cardiomyopathy in an Infant with Atrial Flutter and Prolonged Recovery of Cardiac Function. J Clin Med 2024; 13:3313. [PMID: 38893024 PMCID: PMC11172730 DOI: 10.3390/jcm13113313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/21/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Tachycardia-induced cardiomyopathy (TIC) is caused by prolonged tachycardia, leading to left ventricular dilatation and systolic dysfunction with heart failure. Although TIC is more common in adults, it is rare in early infancy. Methods: Clinical testing was performed as part of medical evaluation and management. Next-generation sequencing (NGS) was conducted for a patient with TIC. A literature review on TIC was also conducted. Results: The case involved a 5-month-old infant referred to the hospital due to symptoms of heart failure lasting at least two months. The infant's heart rate was 200 beats per minute, the left ventricular ejection fraction fell below 14%, and electrocardiograms showed atrial flutter, suggesting TIC. After cardioversion, there was no recurrence of atrial flutter, and cardiac function improved 98 days after tachycardia arrest. The NGS did not identify any pathogenic variants. The literature review identified eight early infantile cases of TIC. However, no previous reports described a case with such a prolonged duration of TIC as ours. Conclusions: This is the first report of a case of prolonged TIC in a child with the documented time to recover normal cardiac function. The improvement of cardiac function depends on the duration of TIC. Early recognition and intervention in TIC are essential to improve outcomes for infantile patients, as timely treatment offers the potential for recovery.
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Affiliation(s)
- Tomohide Sakai
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Kaori Tsuboi
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Shinya Takarada
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Mako Okabe
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Hideyuki Nakaoka
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Keijiro Ibuki
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Sayaka W. Ozawa
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Yukiko Hata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Shojiro Ichimata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
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Borges-Rosa J, Sousa PA, António N, Elvas L, Gonçalves L. Predictors of systolic function recovery after atrial fibrillation ablation in heart failure patients. Rev Port Cardiol 2024:S0870-2551(24)00115-X. [PMID: 38701967 DOI: 10.1016/j.repc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/21/2023] [Accepted: 02/06/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Atrial fibrillation (AF) and heart failure (HF) often coexist. AF catheter ablation improves left ventricular ejection fraction (LVEF), but its impact varies between patients. We aimed to identify predictors of LVEF improvement in HF patients with impaired LVEF undergoing AF ablation. METHODS We conducted a retrospective single-center study in HF patients with LVEF <50% undergoing AF catheter ablation between May 2016 and May 2022. The primary endpoint was the LVEF recovery rate ('responders'). Secondary endpoints were one-year safety and effectiveness. We also aimed to validate a prediction model for LVEF recovery. RESULTS The study included 100 patients (79% male, median age 60 years, 70% with probable tachycardia-induced cardiomyopathy [TIC], mean LVEF 37%, 29% with paroxysmal AF). After a median follow-up of 12 months after catheter ablation, LVEF improved significantly (36±10% vs. 53±10%, p<0.001), with an 82% responder rate. A suspected diagnosis of TIC (OR 4.916 [95% CI 1.166-20.732], p=0.030), shorter QRS duration (OR 0.969 [95% CI 0.945-0.994], p=0.015), and smaller left ventricle (OR 0.893 [95% CI 0.799-0.999], p=0.049) were independently associated with LVEF improvement. Freedom from any documented atrial arrhythmia was 86% (64% under antiarrhythmic drugs), and the rate of adverse events was 2%. The prediction model had a good discriminative performance (AUC 0.814 [95% CI 0.681-0.947]). CONCLUSION In AF patients with HF and impaired LVEF, suspected TIC, shorter QRS duration, and smaller LV diameter were associated with LVEF recovery following AF catheter ablation.
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Affiliation(s)
- João Borges-Rosa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro A Sousa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Natália António
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; iCBR, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Luís Elvas
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; iCBR, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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10
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Zakharov IP, Chomakhidze PS, Kopylov FY, Sultygova EA, Mesitskaya DF, Lyubimova EA, Andreev DA. Determining The Risk of Atrial Fibrillation Paroxysm in Patients With Chronic Heart Failure With Intact and Reduced Ejection Fraction. KARDIOLOGIIA 2024; 64:25-33. [PMID: 38597759 DOI: 10.18087/cardio.2024.3.n2466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/23/2023] [Indexed: 04/11/2024]
Abstract
AIM To determine predictors for the development of atrial fibrillation (AF) in patients with chronic heart failure (CHF) with preserved and reduced ejection fraction by echocardiography (EchoCG) according to an extended protocol with determination of diastolic function and left atrial global strain. MATERIAL AND METHODS Data of 168 patients with stage I-III CHF without a history of AF were analyzed. All patients underwent echocardiography according to an extended protocol with the determination of diastolic dysfunction (DD), left atrial ejection fraction (LA EF), and left atrial global strain (LA GS). Tissue Doppler imaging (TDI) was used to evaluate the early (E) and late (A) LV filling velocity and the early (E') and late (A') diastolic mitral annular velocity. In all patients, Holter ECG monitoring (HM ECG) of heart rhythm was performed for 3 days, and ECG monitoring with telemedicine technologies was performed for 7 days, 3 times a day for 3 minutes. The follow-up period was 3 months or until an AF episode. RESULTS During the study, paroxysmal AF (pAF) was detected in 41 (24.4%) patients using various methods of heart rhythm monitoring. Complaints of palpitations were noted for 10 (24.4%) patients during pAF, which was recorded using a CardioQVARK® device, HM ECG or a 12-lead ECG. In 5 (12.2%) patients, daily ECG monitoring revealed pAF without associated complaints. HM ECG detected 8, 2, 4 (19.5%, 4.8%, and 9.7%) cases during 24, 48 and 72 hours, respectively; a single-channel CardioQVARK® detected 30 (73.2%) cases when used 3 times a day for 7 days. These results showed that AF frequently develops in CHF without accompanying symptoms. The method for detecting pAF with CardioQVARK® showed good results: it was twice more effective than HM ECG and three times more effective than 12-lead ECG. Also, according to ultrasound data, significant changes in the following parameters were noted in patients with AF: LA EF <36% (OR 1.04, 95% CI: 1.02-1.08), p=0.003; LA GS <9.9% (OR 1.16, 95% CI: 1.02-1.38), p<0.001; TDI E med <5.7 cm/s (OR 0.97, 95% CI: 0.94-1.00), p=0.026. Grade 2 DD did not show statistically significant results (OR 1.1, 95% CI: 0.7-1.5, p=0.54). However, it was detected more frequently in patients with AF, in 34% of cases, compared to 29% of cases in patients without AF, which requires further study on a larger patient sample. CONCLUSION Patients with CHF have a high risk of developing pAF (24.4%). 75% of patients with AF do not feel the development of paroxysm. All CHF patients should undergo EchoCG with assessment of LA EF, TDI E med and LA GS to identify a group at risk for the development of AF. Heart rhythm remote monitoring with CardioQVARK® devices can be considered a reliable method for early detection of pAF and timely initiation of anticoagulant therapy in patients with CHF.
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Affiliation(s)
| | | | | | | | | | | | - D A Andreev
- Sechenov First Moscow State Medical University
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11
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De Larochellière H, Brouillette F, Lévesque P, Dognin N, St-Germain R, Rimac G, Lemay S, Philippon F, Sénéchal M. Severity of Left Ventricular Dysfunction in Patients With Tachycardia-Induced Cardiomyopathy: Impacts on Remodeling After Atrial Flutter Ablation. Am J Cardiol 2024; 213:132-139. [PMID: 38114044 DOI: 10.1016/j.amjcard.2023.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023]
Abstract
Tachycardia-induced cardiomyopathy is defined as a reversible left ventricular (LV) systolic dysfunction (SeD) resulting from a sustained fast heart rate. LV remodeling in patients with severe LV dysfunction at diagnosis remains poorly understood. In this retrospective cohort study, we described LV remodeling in 50 patients who underwent atrial flutter ablation. These patients were divided into severe LV SeD (LV ejection fraction [EF] ≤30%) and LV nonsevere SeD (LVEF 31% to 50%) at baseline. All continuous variables are expressed as median and interquartile range. LVEF was 18% (13 to 25) and 38% (34 to 41) in the SeD (n = 29) and LV nonsevere SeD (n = 21) groups, respectively. At baseline, patients with SeD had higher LV end-diastolic diameter (56 [54 to 59] vs 49 mm [47 to 52], p <0.01), LV end-systolic diameter (48 [43 to 51] vs 36 mm [34 to 41], p <0.01), LV end-diastolic volume (71 [64 to 85] vs 56 ml/m2 [46 to 68], p <0.01), LV end-systolic volume (56 [53 to 70] vs 36 ml/m2 [27 to 42], p <0.01), and lower tricuspid annular plane systolic excursion (12 [10 to 13] vs 16 mm [13 to 19], p <0.01). At last follow-up, LVEF was not statistically significantly different between groups. However, LV end-systolic diameter (36 [34 to 39] vs 32 mm [32 to 34], p = 0.01) and LV end-systolic volume (29 [26 to 35] vs 25 ml/m2 [20 to 29], p = 0.02) remained larger in the SeD group. Seven patients (14%), all from the SeD group, had a LVEF ≤35% 2 months after rhythm control, and reverse remodeling was observed up to 9 months. In conclusion, more than half of patients with tachycardia-induced cardiomyopathy and atrial flutter had LVEF ≤30% at baseline. LVEF recovery and LV remodeling were observed beyond 2 months, highlighting the importance of rhythm control and early guideline-directed medical therapy in these patients.
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Affiliation(s)
- Hugo De Larochellière
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - François Brouillette
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Patrick Lévesque
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Nicolas Dognin
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Raphaël St-Germain
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Goran Rimac
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Sylvain Lemay
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - François Philippon
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Mario Sénéchal
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada.
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12
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Erhard N, Bahlke F, Spitzauer L, Englert F, Popa M, Bourier F, Reents T, Lennerz C, Kraft H, Maurer S, Tunsch-Martinez A, Syväri J, Tydecks M, Telishevska M, Lengauer S, Hessling G, Deisenhofer I, Kottmaier M. Renal function and periprocedural complications in patients undergoing left atrial catheter ablation: A comparison between uninterrupted direct oral anticoagulants and phenprocoumon administration. Clin Res Cardiol 2024:10.1007/s00392-024-02374-w. [PMID: 38261026 DOI: 10.1007/s00392-024-02374-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Data regarding uninterrupted oral anticoagulation in patients with chronic kidney disease (CKD) during catheter ablation for left atrial arrhythmias is limited. This study aimed to evaluate the safety and efficacy of periprocedural uninterrupted direct oral anticoagulants (DOAC) compared with uninterrupted phenprocoumon in patients with CKD undergoing left atrial catheter ablation. METHODS AND RESULTS We conducted a retrospective single-center study of patients who underwent left atrial catheter ablation between 2016 and 2019 with underlying chronic kidney disease (glomerular filtration rate (GFR) between 15 and 45 ml/min). The primary objective of this study was to investigate whether direct oral anticoagulant (DOAC) therapy or warfarin presents a superior safety profile in patients with chronic kidney disease (CKD) undergoing left atrial catheter ablation. We compared periprocedural complications (arteriovenous fistula, aneurysm, significant hematoma (> 5 cm)) and/or bleeding (drop in hemoglobin of >2 g/dl, pericardial effusion, retroperitoneal bleeding, other bleeding, stroke) between patients receiving either uninterrupted DOAC or warfarin therapy. Secondary analysis included patient baseline characteristics as well as procedural data. A total of 188 patients (female n = 108 (57%), mean age 75.3 ± 8.1 years, mean GFR 36.8 ± 6 ml/min) were included in this study. Underlying arrhythmias were atrial fibrillation (n = 104, 55.3%) and atypical atrial flutter (n = 84, 44.7%). Of these, n = 132 patients (70%) were under a DOAC medication, and n = 56 (30%) were under phenprocoumon. Major groin complications including pseudoaneurysm and/or AV fistula occurred in 8.9% of patients in the phenprocoumon group vs. 11.3% of patients in the DOAC group, which was not statistically significant (p = 0.62). Incidence of cardiac tamponade (2.3% vs. 0%; p = 0.55) and stroke (0% vs. 0%) were low in both DOAC and phenprocoumon groups with similar post-procedural drops in hemoglobin levels (1.1±1 g/dl vs 1.1±0.9 g/dl; p = 0.71). CONCLUSION The type of anticoagulation had no significant influence on bleeding or thromboembolic events as well as groin complications in this retrospective study. Despite observing an increased rate of groin complications, the uninterrupted use of DOAC or phenprocoumon during left atrial catheter ablation in patients with CKD appears to be feasible and effective.
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Affiliation(s)
- Nico Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Lovis Spitzauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Hannah Kraft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Susanne Maurer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Alexander Tunsch-Martinez
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Jan Syväri
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Madeleine Tydecks
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Gabrielle Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany.
- Kardiologie Neusäß, Oskar-Vonon-Miller-Str. 2a 86356, Neusäß, Germany.
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13
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Onafowokan OO, Ahmad W, McFarland K, Williamson TK, Tretiakov P, Mir JM, Das A, Bell J, Naessig S, Vira S, Lafage V, Paulino C, Diebo B, Schoenfeld A, Hassanzadeh H, Jankowski PP, Hockley A, Passias PG. Impact of congestive heart failure on patients undergoing lumbar spine fusion for adult spine deformity. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:45-52. [PMID: 38644919 PMCID: PMC11029109 DOI: 10.4103/jcvjs.jcvjs_186_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 04/23/2024] Open
Abstract
Background With the increasing amount of elective spine fusion patients presenting with cardiac disease and congestive heart failure, it is becoming difficult to assess when it is safe to proceed with surgery. Assessing the severity of heart failure (HF) through ejection fraction may provide insight into patients' short- and long-term risks. Purpose The purpose of this study was to assess the severity of HF on perioperative outcomes of spine fusion surgery patients. Study Design/Setting This was a retrospective cohort study of the PearlDiver database. Patient Sample We enrolled 670,526 patients undergoing spine fusion surgery. Outcome Measures Thirty-day and 90-day complication rates, discharge destination, length of stay (LOS), physician reimbursement, and hospital costs. Methods Patients undergoing elective spine fusion surgery were isolated and stratified by preoperative HF with preserved ejection fraction (P-EF) or reduced ejection fraction (R-EF) (International Classification of Diseases-9: 428.32 [chronic diastolic HF] and 428.22 [chronic systolic HF]). Means comparison tests (Chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, comorbidities, procedural characteristics, LOS, 30-day and 90-day complication outcomes, and total hospital charges between those diagnosed with P-EF and those not R-EF. Binary logistic regression assessed the odds of complication associated with HF, controlling for levels fused (odds ratio [OR] [95% confidence interval]). Statistical significance was set at P < 0.05. Results Totally 670,526 elective spine fusion patients were included. Four thousand and seventy-seven were diagnosed with P-EF and 2758 R-EF. Overall, P-EF patients presented with higher rates of morbid obesity, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus, and hypertension (all P < 0.001). In relation to No-HF, P-EF patients had higher rates of 30-day major complications including pulmonary embolism, pneumonia, cerebrovascular accident (CVA), myocardial infarctions (MI), sepsis, and death (all P < 0.001). Furthermore, P-EF was associated significantly with increased odds of pneumonia (OR: 2.07 [1.64-2.56], P < 0.001) and sepsis (OR: 2.09 [1.62-2.66], P < 0.001). Relative to No-HF, R-EF was associated with significantly higher odds of MI (OR: 3.66 [2.34-5.47]), CVA (OR: 2.70 [1.67-4.15]), and pneumonia (OR: 1.85 [1.40-2.40]) (all P < 0.001) postoperative within 30 days. Adjusting for prior history of MI, CAD, and the presence of a pacemaker R-EF was a significant predictor of an MI 30 days postoperatively (OR: 2.2 [1.14-4.32], P = 0.021). Further adjusting for history of CABG or stent placement, R-EF was associated with higher odds of CVA (OR: 2.11 [1.09-4.19], P = 0.028) and MI (OR: 2.27 [1.20-4.43], P = 0.013). Conclusions When evaluating the severity of HF before spine surgery, R-EF was associated with a higher risk of major complications, especially the occurrence of a myocardial infarction 30 days postoperatively. During preoperative risk assessment, congestive HF should be considered thoroughly when thinking of postoperative outcomes with emphasis on R-EF.
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Affiliation(s)
- Oluwatobi O. Onafowokan
- Department of Orthopedic and Neurologic Surgery, New York Spine Institute, NYU Langone Orthopedic Hospital, New York
| | - Waleed Ahmad
- Department of Orthopedic and Neurologic Surgery, New York Spine Institute, NYU Langone Orthopedic Hospital, New York
| | - Kimberly McFarland
- Department of Orthopedic and Neurologic Surgery, New York Spine Institute, NYU Langone Orthopedic Hospital, New York
| | - Tyler K. Williamson
- Department of Orthopedic and Neurologic Surgery, New York Spine Institute, NYU Langone Orthopedic Hospital, New York
| | - Peter Tretiakov
- Department of Orthopedic and Neurologic Surgery, New York Spine Institute, NYU Langone Orthopedic Hospital, New York
| | - Jamshaid M. Mir
- Department of Orthopedic and Neurologic Surgery, New York Spine Institute, NYU Langone Orthopedic Hospital, New York
| | - Ankita Das
- Department of Orthopedic and Neurologic Surgery, New York Spine Institute, NYU Langone Orthopedic Hospital, New York
| | - Joshua Bell
- Department of Orthopedics, University of Virginia School of Medicine, Charlottesville, VA
| | - Sara Naessig
- Department of Orthopedic and Neurologic Surgery, New York Spine Institute, NYU Langone Orthopedic Hospital, New York
| | - Shaleen Vira
- Department of Orthopedics, UT Southwestern Medical Center, Dallas, TX
| | - Virginie Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York
| | - Carl Paulino
- Department of Orthopedics, SUNY Downstate Medical Center, Brooklyn, New York
| | - Bassel Diebo
- Department of Orthopedics, Warren Alpert Medical School of Brown University, RI
| | | | - Hamid Hassanzadeh
- Department of Orthopedics, University of Virginia School of Medicine, Charlottesville, VA
| | | | - Aaron Hockley
- Department of Neurosurgery, University of Alberta, Calgary, Canada
| | - Peter Gust Passias
- Department of Orthopedic and Neurologic Surgery, New York Spine Institute, NYU Langone Orthopedic Hospital, New York
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14
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Doehner W, Böhm M, Boriani G, Christersson C, Coats AJS, Haeusler KG, Jones ID, Lip GYH, Metra M, Ntaios G, Savarese G, Shantsila E, Vilahur G, Rosano G. Interaction of heart failure and stroke: A clinical consensus statement of the ESC Council on Stroke, the Heart Failure Association (HFA) and the ESC Working Group on Thrombosis. Eur J Heart Fail 2023; 25:2107-2129. [PMID: 37905380 DOI: 10.1002/ejhf.3071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
Heart failure (HF) is a major disease in our society that often presents with multiple comorbidities with mutual interaction and aggravation. The comorbidity of HF and stroke is a high risk condition that requires particular attention to ensure early detection of complications, efficient diagnostic workup, close monitoring, and consequent treatment of the patient. The bi-directional interaction between the heart and the brain is inherent in the pathophysiology of HF where HF may be causal for acute cerebral injury, and - in turn - acute cerebral injury may induce or aggravate HF via imbalanced neural and neurovegetative control of cardiovascular regulation. The present document represents the consensus view of the ESC Council on Stroke, the Heart Failure Association and the ESC Working Group on Thrombosis to summarize current insights on pathophysiological interactions of the heart and the brain in the comorbidity of HF and stroke. Principal aspects of diagnostic workup, pathophysiological mechanisms, complications, clinical management in acute conditions and in long-term care of patients with the comorbidity are presented and state-of-the-art clinical management and current evidence from clinical trials is discussed. Beside the physicians perspective, also the patients values and preferences are taken into account. Interdisciplinary cooperation of cardiologists, stroke specialists, other specialists and primary care physicians is pivotal to ensure optimal treatment in acute events and in continued long-term treatment of these patients. Key consensus statements are presented in a concise overview on mechanistic insights, diagnostic workup, prevention and treatment to inform clinical acute and continued care of patients with the comorbidity of HF and stroke.
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Affiliation(s)
- Wolfram Doehner
- Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology (Campus Virchow) and German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Saarland University (Kardiologie, Angiologie und Internistische Intensivmedizin), Homburg, Germany
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Karl Georg Haeusler
- Department of Neurology, Universitätsklinikum Würzburg (UKW), Würzburg, Germany
| | - Ian D Jones
- Liverpool Centre for Cardiovascular Science, School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - George Ntaios
- Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Eduard Shantsila
- Department of Primary Care, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gemma Vilahur
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau and CIBERCV, Barcelona, Spain
| | - Giuseppe Rosano
- St George's University Hospital, London, UK, San Raffaele Cassino, Rome, Italy
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15
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Iliodromitis K, Tzeis S, Xintarakou A, Pyrgakis V, Zarifis I, Patsilinakos S, Draganigos A, Triposkiadis F, Hahalis G, Karanasios A, Goudevenos I, Michalis L, Karvounis C, Parthenakis F, Kanakakis I, Tousoulis D, Iliodromitis E, Vardas P. The burden of atrial fibrillation and heart failure in hospitalized patients: A real-world survey in a nationwide snapshot. Hellenic J Cardiol 2023; 74:18-23. [PMID: 37141945 DOI: 10.1016/j.hjc.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/09/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSE Atrial fibrillation (AF) and heart failure (HF) are common and commonly coexisting cardiovascular diseases in hospitalized patients. We report the absolute number and interrelation between AF and HF, assess the daily burden of both diseases on the healthcare system, and describe the medical treatment in a real-world, nationwide conducted snapshot survey. METHODS A questionnaire was equally distributed to various healthcare institutions. Data on the baseline characteristics, prior hospitalizations, and medical treatments of all hospitalized patients with AF and HF at a predefined date were collected and analyzed. RESULTS Seventy-five cardiological departments participated in this multicenter Greek nationwide study. A total of 603 patients (mean age, 74.5 ± 11.4 years) with AF, HF, or the combination of both were nationwide admitted. AF, HF, and the combination of both were registered in 122 (20.2%), 196 (32.5%), and 285 (47.3%) patients, respectively. First-time hospital admission was recorded in 273 (45.7%) of 597 patients, whereas 324 (54.3%) of 597 patients had readmissions in the past 12 months. Of the entire population, 453 (75.1%) were on beta-blockers (BBs), and 430 (71.3%) were on loop diuretics. Furthermore, 315 patients with AF (77.4%) were on oral anticoagulation, of whom 191 (46.9%) were on a direct oral anticoagulant and 124 (30.5%) were on a vitamin K antagonist. CONCLUSION Hospitalized patients with AF and/or HF have more than one admission within a year. Coexistence of AF and HF is more common. BBs and loop diuretics are the most commonly used drugs. More than three-quarters of the patients with AF were on oral anticoagulation.
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Affiliation(s)
- Konstantinos Iliodromitis
- Clinic for Cardiology and Electrophysiology, Evangelical Hospital Hagen-Haspe, Germany & Hellenic Cardioresearch Foundation, Greece; School of Medicine, Witten/Herdecke University, Witten, Germany.
| | - Stylianos Tzeis
- Cardiology Department, Mitera General Hospital, Athens, Greece
| | | | - Vlasios Pyrgakis
- Cardiology Department, G. Gennimatas General Hospital, Athens, Greece
| | - Ioannis Zarifis
- Cardiology Department, Papanicolaou General Hospital, Thessaloniki, Greece
| | | | | | - Filippos Triposkiadis
- Department of Cardiology, Larissa University General Hospital, 413 34, Larissa, Greece
| | - George Hahalis
- Department of Cardiology Medical School, University Hospital of Patra, Patra, Greece
| | | | - Ioannis Goudevenos
- Department of Cardiology Medical School, University Hospital of Ioannina, Ioannina, Greece
| | - Lampros Michalis
- Department of Cardiology Medical School, University Hospital of Ioannina, Ioannina, Greece
| | - Charalampos Karvounis
- First Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Fraggiskos Parthenakis
- Department of Cardiology, Medical School, University Hospital of Heraklion, Crete, Greece
| | | | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panos Vardas
- Professor Emeritus of Cardiology, University of Crete, Former President of the European Society of Cardiology, Mitera General Hospital, HYGEIA Group, Greece & Hellenic Cardioresearch Foundation, Athens, Greece
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16
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Girerd N, Leclercq C, Hanon O, Bayés-Genís A, Januzzi JL, Damy T, Lequeux B, Meune C, Sabouret P, Roubille F. Optimisation of treatments for heart failure with reduced ejection fraction in routine practice: a position statement from a panel of experts. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:813-820. [PMID: 36914024 DOI: 10.1016/j.rec.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/27/2023] [Indexed: 03/15/2023]
Abstract
Major international practice guidelines recommend the use of a combination of 4 medication classes in the treatment of patients with heart failure with reduced ejection fraction (HFrEF) but do not specify how these treatments should be introduced and up-titrated. Consequently, many patients with HFrEF do not receive an optimized treatment regimen. This review proposes a pragmatic algorithm for treatment optimization designed to be easily applied in routine practice. The first goal is to ensure that all 4 recommended medication classes are initiated as early as possible to establish effective therapy, even at a low dose. This is considered preferable to starting fewer medications at a maximum dose. The second goal is to ensure that the intervals between the introduction of different medications and between different titration steps are as short as possible to ensure patient safety. Specific proposals are made for older patients (> 75 years) who are frail, and for those with cardiac rhythm disorders. Application of this algorithm should allow an optimal treatment protocol to be achieved within 2-months in most patients, which should the treatment goal in HFrEF.
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Affiliation(s)
- Nicolas Girerd
- Centre d'Investigations Cliniques-Plurithématique (CIC-P) 14-33, Centre Hospitalier Régional Universitaire (CHRU) de Nancy, Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lorraine, Nancy, France; Cardiovascular and Renal Clinical Trialists network (INI-CRCT), French Clinical Research Infrastructure Network (F-CRIN).
| | - Christophe Leclercq
- Service de Cardiologie, Centre Hospitalier Universitaire de Rennes, Université Rennes 1, Rennes, France; Laboratoire Traitement du Signal et de l'Image (LTSI), Institut National de la Santé et de la Recherche Médicale (INSERM) U642, CIC-IT, 804, Rennes, France
| | - Olivier Hanon
- Service de Gériatrie, Hôpitaux Universitaires Paris Centre, Gérontopôle d'Île-de-France, Université de Paris Cité, Paris, France
| | - Antoni Bayés-Genís
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States; Heart Failure and Biomarker Research, Baim Institute for Clinical Research, Boston, Massachusetts, United States
| | - Thibaut Damy
- Service de Cardiologie, Centre Hospitalier Universitaire Henri Mondor AP-HP, Creteil, France
| | - Benoit Lequeux
- Service de Cardiologie, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Christophe Meune
- Service de Cardiologie, Centre Hospitalier Universitaire Avicenne, Université Paris 13, Bobigny, France
| | - Pierre Sabouret
- Service de Cardiologie, Institut de Cardiologie, Centre Hospitalier Universitaire La Pitié Salpetrière, Sorbonne Université, Paris, France
| | - François Roubille
- Service de Cardiologie, PhyMedExp, Université de Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM) U1046, Centre National de la Recherche Scientifique (CNRS) UMR 9214, Montpellier, France
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17
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Amirova A, Taylor L, Volkmer B, Ahmed N, Chater AM, Fteropoulli T. Informing behaviour change intervention design using systematic review with Bayesian meta-analysis: physical activity in heart failure. Health Psychol Rev 2023; 17:456-484. [PMID: 35701235 DOI: 10.1080/17437199.2022.2090411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 06/02/2022] [Indexed: 12/11/2022]
Abstract
Embracing the Bayesian approach, we aimed to synthesise evidence regarding barriers and enablers to physical activity in adults with heart failure (HF) to inform behaviour change intervention. This approach helps estimate and quantify the uncertainty in the evidence and facilitates the synthesis of qualitative and quantitative studies. Qualitative evidence was annotated using the Theoretical Domains Framework and represented as a prior distribution using an expert elicitation task. The maximum a posteriori probability (MAP) for the probability distribution for the log OR was used to estimate the relationship between physical activity and each determinant according to qualitative, quantitative, and qualitative and quantitative evidence combined. The probability distribution dispersion (SD) was used to evaluate uncertainty in the evidence. Three qualitative and 16 quantitative studies were included (N = 2739). High pro-b-type natriuretic peptide (MAP = -1.16; 95%CrI: [-1.21; -1.11]) and self-reported symptoms (MAP = - 0.48; 95%CrI: [ -0.40; -0.55]) were suggested as barriers to physical activity with low uncertainty (SD = 0.18 and 0.19, respectively). Modifiable barriers were symptom distress (MAP = -0.46; 95%CrI: [-0.68; -0.24], SD = 0.36), and negative attitude (MAP = -0.40; 95%CrI: [-0.49; -0.31], SD = 0.26). Modifiable enablers were social support (MAP = 0.56; 95%CrI: [0.48; 0.63], SD = 0.26), self-efficacy (MAP = 0.43; 95%CrI: [0.32; 0.54], SD = 0.37), positive physical activity attitude (MAP = 0.92; 95%CrI: [0.77; 1.06], SD = 0.36).
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Affiliation(s)
- Aliya Amirova
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lauren Taylor
- Department of Psychology, University of Surrey, Guildford, UK
| | - Brittannia Volkmer
- Psychology department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nafiso Ahmed
- Mental Health Policy Research Unit, UCL Division of Psychiatry, London, UK
| | - Angel M Chater
- Centre for Behaviour Change, Clinical, Educational & Health Psychology, Division of Psychology & Language Sciences, Faculty of Brain Sciences, UCL, London, UK
- Institute for Sport and Physical Activity Research (ISPAR), Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, UK
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18
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Boriani G, Bertini M, Manzo M, Calò L, Santini L, Savarese G, Dello Russo A, Santobuono VE, Lavalle C, Viscusi M, Amellone C, Calvanese R, Santoro A, Rapacciuolo A, Ziacchi M, Arena G, Imberti JF, Campari M, Valsecchi S, D’Onofrio A. Performance of a multi-sensor implantable defibrillator algorithm for heart failure monitoring in the presence of atrial fibrillation. Europace 2023; 25:euad261. [PMID: 37656991 PMCID: PMC10498140 DOI: 10.1093/europace/euad261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023] Open
Abstract
AIMS The HeartLogic Index combines data from multiple implantable cardioverter defibrillators (ICDs) sensors and has been shown to accurately stratify patients at risk of heart failure (HF) events. We evaluated and compared the performance of this algorithm during sinus rhythm and during long-lasting atrial fibrillation (AF). METHODS AND RESULTS HeartLogic was activated in 568 ICD patients from 26 centres. We found periods of ≥30 consecutive days with an atrial high-rate episode (AHRE) burden <1 h/day and periods with an AHRE burden ≥20 h/day. We then identified patients who met both criteria during the follow-up (AHRE group, n = 53), to allow pairwise comparison of periods. For control purposes, we identified patients with an AHRE burden <1 h throughout their follow-up and implemented 2:1 propensity score matching vs. the AHRE group (matched non-AHRE group, n = 106). In the AHRE group, the rate of alerts was 1.2 [95% confidence interval (CI): 1.0-1.5]/patient-year during periods with an AHRE burden <1 h/day and 2.0 (95% CI: 1.5-2.6)/patient-year during periods with an AHRE-burden ≥20 h/day (P = 0.004). The rate of HF hospitalizations was 0.34 (95% CI: 0.15-0.69)/patient-year during IN-alert periods and 0.06 (95% CI: 0.02-0.14)/patient-year during OUT-of-alert periods (P < 0.001). The IN/OUT-of-alert state incidence rate ratio of HF hospitalizations was 8.59 (95% CI: 1.67-55.31) during periods with an AHRE burden <1 h/day and 2.70 (95% CI: 1.01-28.33) during periods with an AHRE burden ≥20 h/day. In the matched non-AHRE group, the rate of HF hospitalizations was 0.29 (95% CI: 0.12-0.60)/patient-year during IN-alert periods and 0.04 (95% CI: 0.02-0.08)/patient-year during OUT-of-alert periods (P < 0.001). The incidence rate ratio was 7.11 (95% CI: 2.19-22.44). CONCLUSION Patients received more alerts during periods of AF. The ability of the algorithm to identify increased risk of HF events was confirmed during AF, despite a lower IN/OUT-of-alert incidence rate ratio in comparison with non-AF periods and non-AF patients. CLINICAL TRIAL REGISTRATION http://clinicaltrials.gov/Identifier: NCT02275637.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Matteo Bertini
- Cardiology Department, University of Ferrara, S. Anna University Hospital, Ferrara, Italy
| | - Michele Manzo
- Cardiology Department, OO.RR. San Giovanni di Dio Ruggi d'Aragona, Salerno, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Luca Santini
- Division of Cardiology, Giovan Battista Grassi’ Hospital, Rome, Italy
| | - Gianluca Savarese
- Division of Cardiology, ‘S. Giovanni Battista’ Hospital, Foligno, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ancona, Italy
| | - Vincenzo Ezio Santobuono
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Policlinico di Bari, Bari, Italy
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Miguel Viscusi
- Cardiology Department, S. Anna e S. Sebastiano Hospital, Caserta, Italy
| | | | | | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Matteo Ziacchi
- Cardiology Unit, Cardio-Thoracic and Vascular Department, S.Orsola University Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Arena
- Cardiology Department, Ospedale Civile Apuane, Massa (MS), Italy
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Campari
- Rhythm Management Division, Boston Scientific, Milan, Italy
| | | | - Antonio D’Onofrio
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi Hospital, Naples, Italy
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19
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Oble MJP, Sonia SN, George S, Shahi SR, Ali Z, Abaza A, Jamil A, Gutlapalli SD, Ali M, Mostafa J. Effectiveness of Catheter Ablation in Left Ventricular Ejection Fraction, Stroke, Quality of Life, All-Cause Mortality, Sinus Rhythm Maintenance, and Hospitalization Rates as Compared to Medical Therapy. Cureus 2023; 15:e43372. [PMID: 37700942 PMCID: PMC10494759 DOI: 10.7759/cureus.43372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023] Open
Abstract
Atrial fibrillation (AF) in the setting of heart failure (HF) accounts for a significant proportion of mortality. AF can be managed either with rate control or rhythm control strategies. Rate control involves the use of beta blockers or calcium channel blockers. Rhythm control methods use antiarrhythmic drugs or catheter ablation (CA) to abolish the rhythm. Articles from PubMed and Google Scholar were chosen for review. The literature was reviewed for data from the last 10 years to be chosen for interpretation. Clinical trials, meta-analyses, and systematic analysis were included in this study. Various health parameters such as all-cause mortality, hospitalization rates, sinus rhythm (SR) maintenance, quality of life improvement, stroke risk, left ventricular ejection fraction (LVEF) improvement, and healthcare costs were analyzed. We demonstrated that CA was superior to medical therapy in reducing all-cause mortality and hospitalization. It leads to significant improvement in LVEF as SR was maintained consistently. Overall, quality of life improved in those who underwent ablation as compared to those who did not. Stroke risk reduction was seen in observational studies only. We recommend CA as first-line therapy for treating patients with AF in the setting of HF. More clinical trials are needed to determine the effectiveness of ablation in reducing stroke risk.
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Affiliation(s)
- Mrinal J P Oble
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shamsun Nahar Sonia
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sherie George
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- General Medicine, Pinderfields Hospital, Wakefield, GBR
| | - Srushti R Shahi
- School of Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine, St. Martinus University Faculty of Medicine (SMUFOM), Willemstad, CUW
| | - Zahra Ali
- School of Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- School of Medicine, Bolan Medical College, Quetta, PAK
| | - Abdelrahman Abaza
- Pathology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, California, USA
| | - Aneeque Jamil
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sai Dheeraj Gutlapalli
- Internal Medicine/Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Marya Ali
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- School of Medicine, Nishtar Medical University, Multan, PAK
| | - Jihan Mostafa
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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20
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He P, Pan Y, Jiang J, Fan F, Zhou J, Xia Y, Liu J, Yang N, Hao Y, Li J, Liu J, Zhao D, Huo Y. In-hospital therapies and determinants of treatment strategy selection in patients with atrial fibrillation and left ventricular systolic dysfunction in China: a retrospective study based on the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project, 2015-2019. BMJ Open 2023; 13:e070070. [PMID: 37277219 DOI: 10.1136/bmjopen-2022-070070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVES The optimal treatment strategy remains debatable in patients with atrial fibrillation (AF) and heart failure. Our objectives were to summarise in-hospital therapies and determine factors associated with treatment strategy selections. DESIGN A retrospective study analysing the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project from 2015 to 2019. SETTING The CCC-AF project included patients from 151 tertiary and 85 secondary hospitals across 30 provinces in China. PARTICIPANTS Patients with AF and left ventricular systolic dysfunction (LVSD, defined as left ventricular ejection fraction<50%) were included, with 5560 patients in the study sample. METHODS Patients were classified by treatment strategies. In-hospital treatments and trends of therapies were analysed. Multiple logistic regression models were used to find determinants of treatment strategies. RESULTS Rhythm control therapies were used in 16.9% of patients with no significant trends (p trend=0.175). Catheter ablation was used in 5.5% of patients, increasing from 3.3% in 2015 to 6.6% in 2019 (p trend<0.001). Factors negatively associated with rhythm control included increased age (OR 0.973, 95% CI 0.967 to 0.980), valvular AF (OR 0.618, 95% CI 0.419 to 0.911), AF types (persistent: OR 0.546, 95% CI 0.462 to 0.645; long-standing persistent: OR 0.298, 95% CI 0.240 to 0.368), larger left atrial diameters (OR 0.966, 95% CI 0.957 to 0.976) and higher Charlson Comorbidity Index scores (CCI 1-2: OR 0.630, 95% CI 0.529 to 0.750; CCI≥3: OR 0.551, 95% CI 0.390 to 0.778). Higher platelet counts (OR 1.025, 95% CI 1.013 to 1.037) and prior rhythm control attempts (electrical cardioversion: OR 4.483, 95% CI 2.369 to 8.483; catheter ablation: OR 4.957, 95% CI 3.072 to 7.997) were positively associated with rhythm control strategies. CONCLUSION In China, non-rhythm control strategy remained the dominant choice in patients with AF and LVSD. Age, AF types, prior treatments, left atrial diameters, platelet counts and comorbidities were major determinants of treatment strategies. Guideline-adherent therapies should be further promoted. STUDY REGISTRATION NUMBER NCT02309398.
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Affiliation(s)
- Pengkang He
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yannan Pan
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jing Zhou
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yulong Xia
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Na Yang
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yongchen Hao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
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21
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Chieng D, Sugumar H, Segan L, Tan C, Vizi D, Nanayakkara S, Al-Kaisey A, Hawson J, Prabhu S, Voskoboinik A, Finch S, Morton JB, Lee G, Mariani J, La Gerche A, Taylor AJ, Howden E, Kistler PM, Kalman JM, Kaye DM, Ling LH. Atrial Fibrillation Ablation for Heart Failure With Preserved Ejection Fraction: A Randomized Controlled Trial. JACC. HEART FAILURE 2023; 11:646-658. [PMID: 36868916 DOI: 10.1016/j.jchf.2023.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/23/2022] [Accepted: 01/04/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Patients with heart failure with preserved ejection fraction (HFpEF) frequently develop atrial fibrillation (AF). There are no randomized trials examining the effects of AF ablation on HFpEF outcomes. OBJECTIVES The aim of this study is to compare the effects of AF ablation vs usual medical therapy on markers of HFpEF severity, including exercise hemodynamics, natriuretic peptide levels, and patient symptoms. METHODS Patients with concomitant AF and HFpEF underwent exercise right heart catheterization and cardiopulmonary exercise testing. HFpEF was confirmed with pulmonary capillary wedge pressure (PCWP) of 15 mm Hg at rest or ≥25 mm Hg on exercise. Patients were randomized to AF ablation vs medical therapy, with investigations repeated at 6 months. The primary outcome was change in peak exercise PCWP on follow-up. RESULTS A total of 31 patients (mean age: 66.1 years; 51.6% females, 80.6% persistent AF) were randomized to AF ablation (n = 16) vs medical therapy (n = 15). Baseline characteristics were comparable across both groups. At 6 months, ablation reduced the primary outcome of peak PCWP from baseline (30.4 ± 4.2 to 25.4 ± 4.5 mm Hg; P < 0.01). Improvements were also seen in peak relative VO2 (20.2 ± 5.9 to 23.1 ± 7.2 mL/kg/min; P < 0.01), N-terminal pro-B-type natriuretic peptide levels (794 ± 698 to 141 ± 60 ng/L; P = 0.04), and MLHF (Minnesota Living with Heart Failure) score (51 ± -21.9 to 16.6 ± 17.5; P < 0.01). No differences were detected in the medical arm. Following ablation, 50% no longer met exercise right heart catheterization-based criteria for HFpEF vs 7% in the medical arm (P = 0.02). CONCLUSIONS AF ablation improves invasive exercise hemodynamic parameters, exercise capacity, and quality of life in patients with concomitant AF and HFpEF.
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Affiliation(s)
- David Chieng
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Hariharan Sugumar
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Louise Segan
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Caleb Tan
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
| | - Donna Vizi
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | - Shane Nanayakkara
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | - Ahmed Al-Kaisey
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia
| | - Joshua Hawson
- University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia
| | - Sandeep Prabhu
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Aleksandr Voskoboinik
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Sue Finch
- University of Melbourne, Melbourne, Australia
| | - Joseph B Morton
- University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia
| | - Geoffrey Lee
- University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia
| | - Justin Mariani
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | - Andre La Gerche
- The Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Andrew J Taylor
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Erin Howden
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
| | - Peter M Kistler
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Jonathan M Kalman
- University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia; Monash University, Melbourne, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; Monash University, Melbourne, Australia.
| | - Liang-Han Ling
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
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22
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Rhee TM, Kim HK, Kim BS, Han KD, Lee HJ, Hwang IC, Lee H, Park JB, Yoon YE, Kim YJ, Cho GY. Impact of coronary artery revascularization on long-term outcome in hypertrophic cardiomyopathy patients: a nationwide population-based cohort study. Sci Rep 2023; 13:6412. [PMID: 37076510 PMCID: PMC10115788 DOI: 10.1038/s41598-023-33344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Abstract
Limited data are available on the long-term outcomes in patients with hypertrophic cardiomyopathy (HCM) patients with significant coronary artery disease (CAD) requiring revascularization. We investigated the risk of cardiovascular outcomes in HCM patients who underwent coronary revascularization compared to the control group without HCM. HCM patients aged ≥ 20 years were enrolled from the Korean National Health Insurance Database. Information on the diagnosis and previous medical history was obtained from the claims data. Cardiovascular outcomes were identified during 8-year after coronary revascularization in HCM patients (HCM group) and matched controls without HCM (non-HCM control group). A total of 431 patients in the HCM group and 1968 in the non-HCM control group were analyzed. The risk of all-cause death, cardiovascular death, sudden cardiac death (SCD), ischemic stroke, and hospitalization due to heart failure was significantly higher in the HCM group than in the non-HCM group, with prominent risk increase of cardiovascular death (adjusted hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.63-3.15, P < 0.001) and ischemic stroke (adjusted HR 2.38, 95% CI 1.55-3.64, P < 0.001). Beyond 1-year after revascularization, the HCM group still had a significantly higher risk of cardiovascular death, SCD, and ventricular fibrillation/tachycardia compared to the non-HCM group. Mortality and major cardiovascular outcomes occurred more frequently in HCM patients with significant CAD requiring revascularization, compared to the matched non-HCM control group. Active and regular surveillance for concomitant risk factors and relevant intervention are warranted in HCM patients at increased risk for CAD.
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Affiliation(s)
- Tae-Min Rhee
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
| | - Bong-Seong Kim
- Department of Statistics and Actuarial Science, The Soongsil University, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, The Soongsil University, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - In-Chang Hwang
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Yeonyee E Yoon
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea
| | - Goo-Yeong Cho
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
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23
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A comprehensive meta-analysis comparing radiofrequency ablation versus pharmacological therapy for the treatment of atrial fibrillation in patients with heart failure. Int J Cardiol 2023; 377:66-72. [PMID: 36709925 DOI: 10.1016/j.ijcard.2023.01.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/10/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) and heart failure (HF) are both associated with worse prognosis and often coexist in the same patients. Whether catheter ablation (CA) is superior to pharmacological therapy in reducing major clinical endpoints in patients with AF and HF is still unsettled. OBJECTIVE To conduct a comprehensive meta-analysis comparing CA with medical therapy (MT) in this population. METHODS We systematically searched for randomized and observational studies comparing clinical outcomes between patients with AF and HF treated with CA or MT. The studied outcomes were mortality, hospitalization, left ventricle ejection fraction (LVEF) and 6-min walking test (6MWT) improvement. RESULTS A total of 12 studies counting 41,377 patients (3611 treated with CA and 37,766 with MT) were included in the analysis. The random-effect model revealed a clear trend in favor of CA in reducing unexpected HF hospitalization (RR 0.72; 95%CI 0.51-1.00; P = 0.05), all-cause death (RR 0.77; 95%CI 0.59-1.01; P = 0.06), all-cause hospitalization (RR 0.84; 95%CI 0.68-1.03; P = 0.09), and the composite of HF hospitalization and death (RR 0.77; 95%CI 0.58-1.02; P = 0.07), compared with MT. Patients treated with CA experienced a better improvement in LVEF (mean difference 6.17; 95%CI 2.98-9.37; P = 0.0002) and 6MWT (mean difference 13.70; 95%CI 3.95-23.45; P = 0.006). When the analysis was limited to randomized controlled trial, CA was found to significantly reduce all-cause death (RR 0.68; 95%CI 0.54-0.86; P = 0.001). CONCLUSION As compared to MT, CA is associated with a better improvement in functional capacity and LVEF, and with a reduction in major clinical endpoints in patients with HF and AF.
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24
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Hsu JC, Yang YY, Chuang SL, Lin LY, Chen THH. Prediabetes as a risk factor for new-onset atrial fibrillation: the propensity-score matching cohort analyzed using the Cox regression model coupled with the random survival forest. Cardiovasc Diabetol 2023; 22:35. [PMID: 36804876 PMCID: PMC9940357 DOI: 10.1186/s12933-023-01767-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The glycemic continuum often indicates a gradual decline in insulin sensitivity leading to an increase in glucose levels. Although prediabetes is an established risk factor for both macrovascular and microvascular diseases, whether prediabetes is independently associated with the risk of developing atrial fibrillation (AF), particularly the occurrence time, has not been well studied using a high-quality research design in combination with statistical machine-learning algorithms. METHODS Using data available from electronic medical records collected from the National Taiwan University Hospital, a tertiary medical center in Taiwan, we conducted a retrospective cohort study consisting 174,835 adult patients between 2014 and 2019 to investigate the relationship between prediabetes and AF. To render patients with prediabetes as comparable to those with normal glucose test, a propensity-score matching design was used to select the matched pairs of two groups with a 1:1 ratio. The Kaplan-Meier method was used to compare the cumulative risk of AF between prediabetes and normal glucose test using log-rank test. The multivariable Cox regression model was employed to estimate adjusted hazard ratio (HR) for prediabetes versus normal glucose test by stratifying three levels of glycosylated hemoglobin (HbA1c). The machine-learning algorithm using the random survival forest (RSF) method was further used to identify the importance of clinical factors associated with AF in patients with prediabetes. RESULTS A sample of 14,309 pairs of patients with prediabetes and normal glucose test result were selected. The incidence of AF was 11.6 cases per 1000 person-years during a median follow-up period of 47.1 months. The Kaplan-Meier analysis revealed that the risk of AF was significantly higher in patients with prediabetes (log-rank p < 0.001). The multivariable Cox regression model indicated that prediabetes was independently associated with a significant increased risk of AF (HR 1.24, 95% confidence interval 1.11-1.39, p < 0.001), particularly for patients with HbA1c above 5.5%. The RSF method identified elevated N-terminal natriuretic peptide and altered left heart structure as the two most important risk factors for AF among patients with prediabetes. CONCLUSIONS Our study found that prediabetes is independently associated with a higher risk of AF. Furthermore, alterations in left heart structure make a significant contribution to this elevated risk, and these structural changes may begin during the prediabetes stage.
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Affiliation(s)
- Jung-Chi Hsu
- Division of Cardiology, Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No.7, Chung-Chan South Road, Taipei, 100, Taiwan
| | - Yen-Yun Yang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Lin Chuang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No.7, Chung-Chan South Road, Taipei, 100, Taiwan. .,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Association of Types of Sleep Apnea and Nocturnal Hypoxemia with Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy. J Clin Med 2023; 12:jcm12041347. [PMID: 36835882 PMCID: PMC9968174 DOI: 10.3390/jcm12041347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Data regarding the association between sleep apnea (SA) and atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) are still limited. We aim to investigate the association of both types of SA, obstructive sleep apnea (OSA) and central sleep apnea (CSA), and nocturnal hypoxemia with AF in HCM. METHODS A total of 606 patients with HCM who underwent sleep evaluations were included. Logistic regression was used to assess the association between sleep disorder and AF. RESULTS SA was presented in 363 (59.9%) patients, of whom 337 (55.6%) had OSA and 26 (4.3%) had CSA. Patients with SA were older, more often male, had a higher body mass index, and more clinical comorbidities. Prevalence of AF was higher in patients with CSA than patients with OSA and without SA (50.0% versus 24.9% and 12.8%, p < 0.001). After adjustment for age, sex, body mass index, hypertension, diabetes mellitus, cigarette use, New York Heart Association class and severity of mitral regurgitation, SA (OR, 1.79; 95% CI, 1.09-2.94) and nocturnal hypoxemia (higher tertile of percentage of total sleep time with oxygen saturation < 90% [OR, 1.81; 95% CI, 1.05-3.12] compared with lower tertile) were significantly associated with AF. The association was much stronger in the CSA group (OR, 3.98; 95% CI, 1.56-10.13) than in OSA group (OR, 1.66; 95% CI, 1.01-2.76). Similar associations were observed when analyses were restricted to persistent/permanent AF. CONCLUSION Both types of SA and nocturnal hypoxemia were independently associated with AF. Attention should be paid to the screening of both types of SA in the management of AF in HCM.
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Elkind MSV, Witte KK, Kasner SE, Sawyer LM, Grimsey Jones FW, Rinciog C, Tsintzos S, Rosemas SC, Lanctin D, Ziegler PD, Reynolds MR. Cost-effectiveness of an insertable cardiac monitor in a high-risk population in the US. BMC Cardiovasc Disord 2023; 23:45. [PMID: 36698055 PMCID: PMC9875401 DOI: 10.1186/s12872-023-03073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Insertable cardiac monitors (ICMs) are a clinically effective means of detecting atrial fibrillation (AF) in high-risk patients, and guiding the initiation of non-vitamin K oral anticoagulants (NOACs). Their cost-effectiveness from a US clinical payer perspective is not yet known. The objective of this study was to evaluate the cost-effectiveness of ICMs compared to standard of care (SoC) for detecting AF in patients at high risk of stroke (CHADS2 ≥ 2), in the US. METHODS Using patient data from the REVEAL AF trial (n = 393, average CHADS2 score = 2.9), a Markov model estimated the lifetime costs and benefits of detecting AF with an ICM or with SoC (specifically intermittent use of electrocardiograms and 24-h Holter monitors). Ischemic and hemorrhagic strokes, intra- and extra-cranial hemorrhages, and minor bleeds were modelled. Diagnostic and device costs, costs of treating stroke and bleeding events and medical therapy-specifically costs of NOACs were included. Costs and health outcomes, measured as quality-adjusted life years (QALYs), were discounted at 3% per annum, in line with standard practice in the US setting. One-way deterministic and probabilistic sensitivity analyses (PSA) were undertaken. RESULTS Lifetime per-patient cost for ICM was $31,116 versus $25,330 for SoC. ICMs generated a total of 7.75 QALYs versus 7.59 for SoC, with 34 fewer strokes projected per 1000 patients. The model estimates a number needed to treat of 29 per stroke avoided. The incremental cost-effectiveness ratio was $35,528 per QALY gained. ICMs were cost-effective in 75% of PSA simulations, using a $50,000 per QALY threshold, and a 100% probability of being cost-effective at a WTP threshold of $150,000 per QALY. CONCLUSIONS The use of ICMs to identify AF in a high-risk population is likely to be cost-effective in the US healthcare setting.
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Affiliation(s)
- Mitchell S. V. Elkind
- grid.21729.3f0000000419368729Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Klaus K. Witte
- grid.9909.90000 0004 1936 8403Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ,grid.412301.50000 0000 8653 1507University Clinic, RWTH, Aachen, Germany
| | - Scott E. Kasner
- grid.25879.310000 0004 1936 8972Department of Neurology, University of Pennsylvania, Philadelphia, PA USA
| | | | | | | | | | | | - David Lanctin
- grid.419673.e0000 0000 9545 2456Medtronic, Mounds View, MN USA
| | - Paul D. Ziegler
- grid.419673.e0000 0000 9545 2456Medtronic, Mounds View, MN USA
| | - Matthew R. Reynolds
- grid.488688.20000 0004 0422 1863Baim Institute for Clinical Research, Boston, MA USA ,grid.415731.50000 0001 0725 1353Lahey Hospital and Medical Center, Burlington, MA USA
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Báez Cabanillas MV, Colque R, Tibaldi MÁ, Kaplinsky E, Perrone S, Barbagelata A. Emerging concepts in heart failure management and treatment: focus on tachycardia-induced cardiomyopathy. Drugs Context 2023; 12:dic-2022-8-4. [PMID: 36660016 PMCID: PMC9828873 DOI: 10.7573/dic.2022-8-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/07/2022] [Indexed: 01/04/2023] Open
Abstract
Tachycardia-induced cardiomyopathy is an entity characterized by reversible dysfunction of the left ventricle, which can be induced by different types of arrhythmia such as atrial fibrillation, atrial flutter, incessant supraventricular tachycardia and ventricular arrhythmia (more frequent causes). Correct identification of the causative arrhythmia and normalization of the heart rate (e.g through medical treatment, electrical cardioversion, ablation) can lead to recovery of left ventricular function. Tachycardia-induced cardiomyopathy should be suspected in patients with tachycardia and left ventricular dysfunction (heart failure setting), especially when there is no history of previous heart disease. Its usual phenotype is that of non-ischaemic/non-valvular dilated cardiomyopathy and it can occur in both children (main cause: permanent junctional reciprocating tachycardia) and adults (main cause: atrial fibrillation). With proper treatment, most cases recover within a few months, though there is a risk of relapse, especially when the causal arrhythmia reappears or its control is lost. This is a narrative review that comprehensively addresses the pathophysiology, clinical manifestations, and therapeutic management of tachycardia-induced cardiomyopathy. This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment.
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Affiliation(s)
- María Victoria Báez Cabanillas
- Catholic University of Argentina, Buenos Aires, Argentina,Cardiovascular Medicine Department, Sanatorio Allende, Córdoba, Argentina
| | - Roberto Colque
- Cardiovascular Medicine Department, Sanatorio Allende, Córdoba, Argentina
| | | | - Edgardo Kaplinsky
- Cardiology Unit, Medicine Department, Hospital Municipal de Badalona, Barcelona, Spain
| | - Sergio Perrone
- Catholic University of Argentina, Buenos Aires, Argentina,Fleni Institute, Buenos Aires, Argentina
| | - Alejandro Barbagelata
- Catholic University of Argentina, Buenos Aires, Argentina,Duke University School of Medicine, Durham, NC, USA
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Evaluation of handcrafted features and learned representations for the classification of arrhythmia and congestive heart failure in ECG. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zakeri R, Ahluwalia N, Tindale A, Omar F, Packer M, Khan H, Baker V, Honarbakhsh S, Earley MJ, Sporton S, Schilling RJ, Jones D, Markides V, Hunter RJ, Wong T. Long-term outcomes following catheter ablation versus medical therapy in patients with persistent atrial fibrillation and heart failure with reduced ejection fraction. Eur J Heart Fail 2023; 25:77-86. [PMID: 36221809 DOI: 10.1002/ejhf.2714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 02/01/2023] Open
Abstract
AIMS The ARC-HF and CAMTAF trials randomized patients with persistent atrial fibrillation (AF) and heart failure (HF) to early routine catheter ablation (ER-CA) versus pharmacological rate control (RC). After trial completion, delayed selective catheter ablation (DS-CA) was performed where clinically indicated in the RC group. We hypothesized that ER-CA would result in a lower risk of cardiovascular hospitalization and death versus DS-CA in this population. METHODS AND RESULTS Overall, 102 patients were randomized (age 60 ± 11 years, left ventricular ejection fraction [LVEF] 31 ± 11%): 52 to ER-CA and 50 to RC. After 12 months, patients undergoing ER-CA had improved self-reported symptom scores, lower New York Heart Association class (i.e. better functional capacity), and higher LVEF compared to patients receiving RC alone. During a median follow-up of 7.8 (interquartile range 3.9-9.9) years, 27 (54%) patients in the RC group underwent DS-CA and 34 (33.3%) patients died, including 17 (32.7%) randomized to ER-CA and 17 (34.0%) randomized to RC. Compared with DS-CA, a strategy of ER-CA exhibited similar risk of all-cause mortality (adjusted hazard ratio [aHR] 0.89, 95% confidence interval [CI] 0.44-1.77, p = 0.731) and combined all-cause mortality or cardiovascular hospitalization (aHR 0.80, 95% CI 0.43-1.47, p = 0.467). However, analyses according to treatment received suggested an association between CA and improved outcomes versus RC (all-cause mortality: aHR 0.43, 95% CI 0.20-0.91, p = 0.028; all-cause mortality/cardiovascular hospitalization: aHR 0.48, 95% CI 0.24-0.94, p = 0.031). CONCLUSIONS In patients with persistent AF and HF, ER-CA produces similar long-term outcomes to a DS-CA strategy. The association between CA as a treatment received and improved outcomes means there is still a lack of clarity regarding the role of early CA in selected patients. Randomized trials are needed to clarify this question.
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Affiliation(s)
- Rosita Zakeri
- British Heart Foundation Centre for Research Excellence, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Nikhil Ahluwalia
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alexander Tindale
- Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Fatima Omar
- Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Matthew Packer
- Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Habib Khan
- Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | | | - David Jones
- Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Vias Markides
- Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
| | | | - Tom Wong
- British Heart Foundation Centre for Research Excellence, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Royal Brompton and Harefield Hospitals, Guys and St Thomas' NHS Foundation Trust, London, UK
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Polypharmacy and Major Adverse Events in Atrial Fibrillation. J Cardiovasc Pharmacol 2022; 80:826-831. [PMID: 35921643 DOI: 10.1097/fjc.0000000000001339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/02/2022] [Indexed: 12/13/2022]
Abstract
ABSTRACT Patients with atrial fibrillation (AF) often receive multiple medications daily. The purpose of this study was to examine the prognostic implications of polypharmacy in patients with AF. This is a retrospective post hoc analysis of 1113 AF patients, enrolled in a randomized trial during an acute hospitalization (MISOAC-AF, NCT02941978). The presence of polypharmacy (use of >4 drugs daily) was assessed at hospital discharge. Regression analyses were performed to identify clinical predictors of polypharmacy and compare the outcomes of patients with or without confirmed polypharmacy. The coprimary outcomes were all-cause and cardiovascular (CV) mortality. Among patients with polypharmacy, the difference in the risk of mortality was also assessed per each added drug as a numeric variable. Polypharmacy was found in 36.9% of participants. Dyslipidemia, coronary artery disease, lower left ventricular ejection fraction, and higher glomerular filtration rates were independent predictors of polypharmacy. Polypharmacy was an independent predictor for all-cause death (adjusted hazard ratio [aHR]: 1.29, 95% confidence interval [CI]: 1.01-1.64) and CV death (aHR: 1.39, 95% CI: 1.05-1.84). Among patients with polypharmacy, each additional concomitant medication was independently associated with a 4% increased risk of all-cause mortality (aHR = 1.04, 95% CI: 1.00-1.08) and a 5% increased risk of CV mortality (aHR = 1.05, 95% CI: 1.00-1.10). Polypharmacy was common among patients with AF hospitalized in a tertiary hospital and was incrementally associated with higher rates of mortality.
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Hao Z, Xu G, Yuan M, Sun Y, Tan R, Liu Y, Xia Y. The predictive value of changes in left atrial volume index for rehospitalization in heart failure with preserved ejection fraction. Clin Cardiol 2022; 46:151-158. [PMID: 36403261 PMCID: PMC9933114 DOI: 10.1002/clc.23952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/27/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022] Open
Abstract
AIMS Left atrial volume index (LAVI) is an adequate analysis to predicate the left ventricle (LV) filling pressures, providing a powerful predictive marker of LV diastolic dysfunction. LAVI is a dynamic morphophysiological marker, and whether LAVI changes can predicate clinical outcomes in HF with preserved ejection fraction (HFpEF) is unknown. METHODS HFpEF patients were retrospectively studied from the First Affiliated Hospital of Dalian Medical University. Patients were classified into deteriorated, stable and improved groups according to the change in LAVI. Rehospitalization was defined as the main endpoint, the composite outcome of rehospitalization or all-cause death was defined as the secondary endpoint. RESULTS A total of 409 patients were included. In this cohort, the percentage of deteriorated, stable, and improved LAVI were 99 (24.2%), 235 (57.4%), and 75 (18.4%), respectively. During the 22 months follow-up period, 168 patients (41.1%) were rehospitalized, 31 patients (7.5%) died and 182 patients (44.5%) experienced a composite outcome. Multivariate Cox regression showed that compared to improved LAVI, those with deteriorated and stable LAVI experienced higher risk of rehospitalization. Logistic regression showed atrial fibrillation (AF) and higher creatinine were independent predictors of deteriorated LAVI, whereas the use of loop diuretics, calcium channel blockers (CCB), and high level of high-density lipoprotein cholesterol (HDL-C) were significantly associated with improved LAVI. CONCLUSIONS Change in LAVI provides a powerful and dynamic morphophysiological marker of LV filling status and can be used to evaluate the rehospitalization in HFpEF patients.
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Affiliation(s)
- Zhujing Hao
- Institute of Cardiovascular DiseasesThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Guiwen Xu
- Institute of Cardiovascular DiseasesThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Mengyang Yuan
- Institute of Cardiovascular DiseasesThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yuxi Sun
- Institute of Cardiovascular DiseasesThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Ruopeng Tan
- Institute of Cardiovascular DiseasesThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yang Liu
- Institute of Cardiovascular DiseasesThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yun‐Long Xia
- Institute of Cardiovascular DiseasesThe First Affiliated Hospital of Dalian Medical UniversityDalianChina,Department of Cardiology, Institute of Heart and Vascular DiseasesThe First Affiliated Hospital of Dalian Medical UniversityDalianChina
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Chen C, Cheng K, Gao X, Zou T, Pang Y, Ling Y, Xu Y, Xu Y, Chen Q, Zhu W, Ge J. Cryoballoon ablation for atrial fibrillation in patients with heart failure with mildly reduced and preserved ejection fraction. ESC Heart Fail 2022; 10:518-531. [PMID: 36325978 PMCID: PMC9871672 DOI: 10.1002/ehf2.14212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Limited data are available on the outcomes of cryoballoon ablation (CBA)-based pulmonary vein isolation (PVI) for atrial fibrillation (AF) in patients with heart failure (HF) with preserved ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF). The present study aimed to evaluate the safety and effectiveness of CBA in such patients. METHODS AND RESULTS Consecutive patients with AF referred for CBA-based PVI from two highly experienced electrophysiology centres were included in this retrospective study. Of 651 patients undergoing CBA, 471 cases were divided into four groups: No HF (n = 255), HFpEF (n = 101), HFmrEF (n = 78), and HF with reduced ejection fraction (n = 37). Similar early recurrence of atrial arrhythmia was found among groups (16.2% vs. 15.4% vs. 14.9% vs. 12.2%, P = 0.798), and no significant difference of long-term sinus rhythm (SR) maintenance was identified among the HFmrEF, HFpEF, and No HF groups (71.8% vs. 75.2% vs. 79.6%, P = 0.334). CBA is safe for patients with HFmrEF and HFpEF with similar complications compared with the No HF group (3.8% vs. 4.0% vs. 3.1%, P = 0.814). The reassessment of cardiac function after CBA showed that patients with HF indicated beneficial outcomes. Left atrial diameter (LAD) and left ventricular ejection fraction were significantly improved in the HFmrEF group. There were 41.6% of patients in the HFpEF group who were completely relieved from HF. LAD and New York Heart Association (NYHA) were associated with recurrence in the HFpEF and HFmrEF groups, and the maintenance of SR was an independent predictor of NYHA improvement for all HF groups. CONCLUSIONS Patients with HFmrEF and HFpEF could benefit from CBA with high SR maintenance and significant HF improvement.
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Affiliation(s)
- Chaofeng Chen
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Kuan Cheng
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Xiaofei Gao
- Department of CardiologyAffiliated Hangzhou First People's Hospital, Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Tian Zou
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Yang Pang
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Yunlong Ling
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Ye Xu
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Yizhou Xu
- Department of CardiologyAffiliated Hangzhou First People's Hospital, Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Qingxing Chen
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Wenqing Zhu
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
| | - Junbo Ge
- Department of CardiologyShanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan UniversityShanghaiChina
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Nezami Z, Holm H, Ohlsson M, Molvin J, Korduner J, Bachus E, Zaghi A, Dieden A, Platonov PG, Jujic A, Magnusson M. The impact of myocardial fibrosis biomarkers in a heart failure population with atrial fibrillation—The HARVEST-Malmö study. Front Cardiovasc Med 2022; 9:982871. [PMID: 36337899 PMCID: PMC9626526 DOI: 10.3389/fcvm.2022.982871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/30/2022] [Indexed: 11/26/2022] Open
Abstract
Background Several studies suggest that circulating biomarkers of myocardial fibrosis are associated with worse prognosis in subjects with atrial fibrillation (AF). Here, we aimed to explore associations between fibrosis biomarkers, prevalent AF, and left atrial volume (LAV) enlargement in subjects with heart failure (HF). Additionally, we evaluated the prognostic impact of fibrotic biomarkers in HF with co-existing AF. Materials and methods Patients hospitalized for HF (n = 316, mean age 75 years; 30% women) were screened for AF. Seven proteins previously associated with myocardial fibrosis [metalloproteinase inhibitor 4 (TIMP-4), suppression of tumorigenicity 2 (ST-2), galectin-3 (GAL-3), growth/differentiation factor-15 (GDF-15), and matrix metalloproteinase 2, 3, and 9 (MMP-3, MMP-3, and MMP-9, respectively)] were analyzed using a proximity extension assay. Proteins with significant Bonferroni-corrected associations with mortality and re-hospitalization risk were taken forward to multivariable Cox regression analyses. Further, Bonferroni-corrected multivariable logistic regression models were used to study associations between protein plasma levels, prevalent AF, and severely enlarged left atrial volume index (LAVI ≥ 48 ml/m2). Results Prevalent AF was observed in 194 patients at the hospitalization of whom 178 (92%) were re-hospitalized and 111 (57%) died during the follow-up period. In multivariable logistic regression models, increased plasma levels of TIMP-4, GDF-15, and ST-2 were associated with the prevalence of AF, whereas none of the seven proteins showed any significant association with severely enlarged LAVI. Increased plasma levels of five proteins yielded significant associations with all-cause mortality in patients with co-existing AF; TIMP-4 (HR 1.33; CI95% 1.07–1.66; p = 0.010), GDF-15 (HR 1.30; CI95% 1.05–1.62; p = 0.017), GAL-3 (HR 1.29; CI95% 1.03–1.61; p = 0.029), ST-2 (HR 1.48; CI95% 1.18–1.85; p < 0.001), and MMP-3 (HR 1.33; CI95% 1.09–1.63; p = 0.006). None of the proteins showed any significant association with re-hospitalization risk. Conclusion In this study, we were able to demonstrate that elevated levels of three plasma proteins previously linked to myocardial fibrosis are associated with prevalent AF in a HF population. Additionally, higher levels of five plasma proteins yielded an increased risk of mortality in the HF population with or without co-existing AF.
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Affiliation(s)
- Zainu Nezami
- Department of Internal Medicine, Sweden Lund University, Skane University Hospital, Lund, Sweden
| | - Hannes Holm
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Lund University, Skane University Hospital, Malmö, Sweden
- *Correspondence: Hannes Holm,
| | - Marcus Ohlsson
- Department of Internal Medicine, Sweden Lund University, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - John Molvin
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Lund University, Skane University Hospital, Malmö, Sweden
| | - Johan Korduner
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Erasmus Bachus
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Amir Zaghi
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anna Dieden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | - Amra Jujic
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Lund University, Skane University Hospital, Malmö, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Lund University, Skane University Hospital, Malmö, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Hypertension in Africa Research Team (HART), North West University Potchefstroom, Potchefstroom, South Africa
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Agbor VN, Tianyi FL, Aminde LN, Mbanga CM, Petnga SJN, Simo LP, Dzudie A, Chobufo MD, Noubiap JJ. Burden of atrial fibrillation among adults with heart failure in sub-Saharan Africa: a systematic review and meta-analysis. BMJ Open 2022; 12:e061618. [PMID: 36223967 PMCID: PMC9562316 DOI: 10.1136/bmjopen-2022-061618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to estimate the prevalence of atrial fibrillation (AF) in adults with heart failure (HF) and summarise the all-cause mortality ratio among adult patients with coexisting HF and AF in sub-Saharan Africa (SSA). SETTING This was a systematic review and meta-analysis of cross-sectional and cohort studies with primary data on the prevalence and incidence of AF among patients with HF and the all-cause mortality ratio among patients with HF and AF in SSA. We combined text words and MeSH terms to search MEDLINE, PubMed and Global Health Library through Ovid SP, African Journals Online and African Index Medicus from database inception to 10 November 2021. Random-effects meta-analysis was used to estimate pooled prevalence. PRIMARY OUTCOME MEASURES The prevalence and incidence of AF among patients with HF, and the all-cause mortality ratio among patients with HF and AF. RESULTS Twenty-seven of the 1902 records retrieved from database searches were included in the review, totalling 9987 patients with HF. The pooled prevalence of AF among patients with HF was 15.6% (95% CI 12.0% to 19.6%). At six months, the all-cause mortality was 18.4% (95% CI 13.1% to 23.6%) in a multinational registry and 67.7% (95% CI 51.1% to 74.3%) in one study in Tanzania. The one-year mortality was 48.6% (95% CI 32.5% to 64.7%) in a study in the Democratic Republic of Congo. We did not find any study reporting the incidence of AF in HF. CONCLUSION AF is common among patients with HF in SSA, and patients with AF and HF have poor survival. There is an urgent need for large-scale population-based prospective data to reliably estimate the prevalence, incidence and risk of mortality of AF among HF patients in SSA to better understand the burden of AF in patients with HF in the region. PROSPERO REGISTRATION NUMBER CRD42018087564.
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Affiliation(s)
- Valirie Ndip Agbor
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Population Health Research, Health Education and Research Organisation, Buea, Southwest, Cameroon
| | | | - Leopold Ndemnge Aminde
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | | | - Saint Just N Petnga
- Kousseri Regional Hospital, Far-North Regional Delegation for Health, Kousseri, Cameroon
| | - Larissa Pone Simo
- General Practice, Dzeng Sub-divisional Hospital, Dzeng, Centre Region, Cameroon
| | - Anastase Dzudie
- Cardiology and Cardiac Pacing Unit, Department of Medicine, Douala General Hospital, Douala, Cameroon
| | - Muchi Ditah Chobufo
- Department of Cardiovascular Diseases Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia, University of Adelaide CHRD, Adelaide, South Australia, Australia
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Lee D, Chang T, Chang S, Lin Y, Lo L, Hu Y, Chung F, Tuan T, Chao T, Liao J, Lin C, Kuo L, Liu C, Chen S. Clinical outcomes and structural remodelling after ablation of atrial fibrillation in heart failure with mildly reduced or mid-range ejection fraction. ESC Heart Fail 2022; 10:177-188. [PMID: 36178105 PMCID: PMC9871718 DOI: 10.1002/ehf2.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/02/2022] [Accepted: 09/15/2022] [Indexed: 01/29/2023] Open
Abstract
AIMS The efficacy of catheter ablation (CA) on clinical outcomes and cardiac structural remodelling in atrial fibrillation (AF) patients with HF with mildly reduced or mid-range ejection fraction (HFmrEF) remains unclear. We aimed to compare the efficacy of CA with medical therapy (MT) in AF patients with HFmrEF. METHODS AND RESULTS We retrospectively screened a total of 36 879 patients with AF between 2005 and 2020. Patients who were initially diagnosed with echocardiography-proved HFmrEF and had follow-up echocardiography were enrolled. After applying propensity score matching in a 1:1 ratio, 72 patients treated by CA (Group 1) and 72 patients receiving MT (Group 2) were taken into further analysis. The co-morbidities were similar between the two groups, except for hyperlipidaemia. After a mean follow-up duration of 58.9 ± 42.6 months, Group 1 had a lower HF hospitalization and all-cause mortality compared with Group 2 (hazard ratio (HR), 0.089 [95% confidence interval (CI), 0.011-0.747]; P = 0.026 and HR, 0.121 [95% CI, 0.016-0.894]; P = 0.038, respectively). As for cardiac structural remodelling, the Group 1 had a better improvement in left ventricular ejection fraction (LVEF) and a more decreased left atrium (LA) diameter than Group 2 (+25.0% ± 18.0% vs. +6.2% ± 21.6%, P = <0.0001 and -1.6 ± 4.7 mm vs. +1.5 ± 8.2 mm, P = 0.008, respectively). CONCLUSIONS In patients with HFmrEF and AF, CA of AF could reduce both HF hospitalization and all-cause mortality as compared with those with MT. A significant improvement in LVEF and decrease in LA diameter were also observed in the CA group. Early rhythm control with CA should be taken into consideration in patients with HFmrEF and AF.
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Affiliation(s)
- Dan‐Ying Lee
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ting‐Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,National Taipei University of Nursing and Health SciencesTaipeiTaiwan
| | - Shih‐Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Yenn‐Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Li‐Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Yu‐Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Fa‐Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ta‐Chuan Tuan
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Tze‐Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Jo‐Nan Liao
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chin‐Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chih‐Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Shih‐Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, and Cardiovascular Research InstituteNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Cardiovascular CenterTaichung Veterans General HospitalTaichungTaiwan
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Diaz J, Martinez F, Calderon JM, Fernandez A, Sauri I, Uso R, Trillo JL, Redon J, Forner MJ. Incidence and impact of atrial fibrillation in heart failure patients: real-world data in a large community. ESC Heart Fail 2022; 9:4230-4239. [PMID: 36111519 PMCID: PMC9773729 DOI: 10.1002/ehf2.14124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 07/27/2022] [Accepted: 08/15/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The objective of the present study is to assess the bidirectional association between heart failure (HF) and atrial fibrillation (AF) using real-world data. METHODS AND RESULTS From an electronic health recording with a population of 3 799 885 adult subjects, those with prevalent or incident HF were selected and followed throughout a study period of 5 years. Prevalence and incidence of AF, and their impact in the risk for acute HF hospitalization, worsening renal function, ischaemic and haemorrhagic stroke, and all-cause mortality were identified. We analysed all incident and prevalent patients with HF and AF, 128 086 patients (S1), and subsequently analysed a subset of patients with incident HF and AF, 57 354 patients (S2). We analysed all incident and prevalent patients with HF and AF, 128 086 patients (S1), and subsequently a subset of patients with incident HF and AF, 57 354 patients (S2). The prevalence of AF was 59 906 (46.7%) of the HF patients, while incidence in the S2 was 231/1000 patients/year. In both cohorts, S1 and S2, AF significantly increases the risk of acute heart failure hospitalization [incidence 79.1/1000 and 97.5/1000 patients/year; HR 1.53 (1.48-1.59 95% CI) and HR 1.32 (1.24-1.41 95% CI), respectively], risk of decreased renal function (eGFR reduced by >20%) [66.2/1000 and 94.0/1000 patients/year; HR 1.13 (1.09-1.18 95% CI) and HR 1.22 (1.14-1.31 95% CI), respectively] and all-cause mortality [203/1000 and 294/1000 patients/year; HR 1.62 (1.58-1.65 95% CI) and HR 1.65 (1.59-1.70 95% CI), respectively]. The number of episodes of hospitalization for acute heart failure was also significantly higher in the AF patients (27 623 vs. 10 036, P < 0.001). However, the risk for ischaemic stroke was reduced in the AF subjects [HR 0.66 (0.63-0.74 95% CI)], probably due to the anticoagulant treatment. CONCLUSIONS AF is associated with an increment in the risk of episodes of acute heart failure as well as decline of renal function and increment of all-cause mortality.
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Affiliation(s)
- Javier Diaz
- Cardiovascular and Renal Research Group, INCLIVA Research InstituteUniversity of ValenciaValenciaSpain
| | - Fernando Martinez
- Cardiovascular and Renal Research Group, INCLIVA Research InstituteUniversity of ValenciaValenciaSpain,Internal Medicine Hospital Clínico de ValenciaValenciaSpain
| | - Jose Miguel Calderon
- Cardiovascular and Renal Research Group, INCLIVA Research InstituteUniversity of ValenciaValenciaSpain
| | - Antonio Fernandez
- Cardiovascular and Renal Research Group, INCLIVA Research InstituteUniversity of ValenciaValenciaSpain
| | - Inmaculada Sauri
- Cardiovascular and Renal Research Group, INCLIVA Research InstituteUniversity of ValenciaValenciaSpain
| | - Ruth Uso
- Cardiovascular and Renal Research Group, INCLIVA Research InstituteUniversity of ValenciaValenciaSpain
| | - Jose Luis Trillo
- Cardiovascular and Renal Research Group, INCLIVA Research InstituteUniversity of ValenciaValenciaSpain
| | - Josep Redon
- Cardiovascular and Renal Research Group, INCLIVA Research InstituteUniversity of ValenciaValenciaSpain,CIBERObn Carlos III InstituteMadridSpain
| | - Maria Jose Forner
- Cardiovascular and Renal Research Group, INCLIVA Research InstituteUniversity of ValenciaValenciaSpain,Internal Medicine Hospital Clínico de ValenciaValenciaSpain
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Johner N, Namdar M, C Shah D. Safety, Efficacy and Prognostic Benefit of Atrial Fibrillation Ablation in Heart Failure with Preserved Ejection Fraction. Arrhythm Electrophysiol Rev 2022; 11:e18. [PMID: 36304203 PMCID: PMC9585645 DOI: 10.15420/aer.2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/23/2022] [Indexed: 11/25/2022] Open
Abstract
Up to 65% of patients with heart failure with preserved ejection fraction (HFpEF) develop AF during the course of the disease. This occurrence is associated with adverse outcomes, including pump failure death. Because AF and HFpEF are mutually reinforcing risk factors, sinus rhythm restoration may represent a disease-modifying intervention. While catheter ablation exhibits acceptable safety and efficacy profiles, no randomised trials have compared AF ablation with medical management in HFpEF. However, catheter ablation has been reported to result in lower natriuretic peptides, lower filling pressures, greater peak cardiac output and improved functional capacity in HFpEF. There is growing evidence that catheter ablation may reduce HFpEF severity, hospitalisation and mortality compared to medical management. Based on indirect evidence, early catheter ablation and minimally extensive atrial injury should be favoured. Hence, individualised ablation strategies stratified by stepwise substrate inducibility provide a logical basis for catheter-based rhythm control in this heterogenous population. Randomised trials are needed for definitive evidence-based guidelines.
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Affiliation(s)
- Nicolas Johner
- Cardiology Division, Geneva University Hospital, Geneva, Switzerland
| | - Mehdi Namdar
- Cardiology Division, Geneva University Hospital, Geneva, Switzerland
| | - Dipen C Shah
- Cardiology Division, Geneva University Hospital, Geneva, Switzerland
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38
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Patel AH, Natarajan B, Pai RG. Current Management of Heart Failure with Preserved Ejection Fraction. Int J Angiol 2022; 31:166-178. [PMID: 36157094 PMCID: PMC9507602 DOI: 10.1055/s-0042-1756173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) encompasses nearly half of heart failure (HF) worldwide, and still remains a poor prognostic indicator. It commonly coexists in patients with vascular disease and needs to be recognized and managed appropriately to reduce morbidity and mortality. Due to the heterogeneity of HFpEF as a disease process, targeted pharmacotherapy to this date has not shown a survival benefit among this population. This article serves as a comprehensive historical review focusing on the management of HFpEF by reviewing past, present, and future randomized controlled trials that attempt to uncover a therapeutic value. With a paradigm shift in the pathophysiology of HFpEF as an inflammatory, neurohormonal, and interstitial process, a phenotypic approach has increased in popularity focusing on the treatment of HFpEF as a systemic disease. This article also addresses common comorbidities associated with HFpEF as well as current and ongoing clinical trials looking to further elucidate such links.
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Affiliation(s)
- Akash H. Patel
- Department of Internal Medicine, University of California Irvine Medical Center, Orange, California
| | - Balaji Natarajan
- Department of Cardiology, University of California Riverside School of Medicine, Riverside, California
- Department of Cardiology, St. Bernardine Medical Center, San Bernardino, California
| | - Ramdas G. Pai
- Department of Cardiology, University of California Riverside School of Medicine, Riverside, California
- Department of Cardiology, St. Bernardine Medical Center, San Bernardino, California
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39
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Ruiz-Canela M, Guasch-Ferré M, Razquin C, Toledo E, Hernández-Alonso P, Clish CB, Li J, Wittenbecher C, Dennis C, Alonso-Gómez Á, Almanza-Aguilera E, Liang L, Corella D, Gómez-Gracia E, Estruch R, Fiol M, Lapetra J, Serra-Majem L, Ros E, Arós F, Salas-Salvadó J, Hu FB, Martínez-González MÁ. Plasma acylcarnitines and risk of incident heart failure and atrial fibrillation: the Prevención con dieta mediterránea study. REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH EDITION) 2022; 75:649-658. [PMID: 34866031 PMCID: PMC9160218 DOI: 10.1016/j.rec.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES Fatty acid metabolic dysregulation in mitochondria is a common mechanism involved in the development of heart failure (HF) and atrial fibrillation (AF). We evaluated the association between plasma acylcarnitine levels and the incidence of HF or AF, and whether the mediterranean diet (MedDiet) may attenuate the association between acylcarnitines and HF or AF risk. METHODS Two case-control studies nested within the Prevención con dieta mediterránea (PREDIMED) trial. High cardiovascular risk participants were recruited in Spain: 326 incident HF and 509 AF cases individually matched to 1 to 3 controls. Plasma acylcarnitines were measured with high-throughput liquid chromatography-tandem mass spectrometry. Conditional logistic regression models were fitted to estimate multivariable OR and 95%CI. Additive and multiplicative interactions were assessed by intervention group, obesity (body mass index ≥ 30 kg/m2), and type 2 diabetes. RESULTS Elevated levels of medium- and long-chain acylcarnitines were associated with increased HF risk (adjusted ORperDE, 1.28; 95%CI, 1.09-1.51 and adjusted ORperDE, 1.21; 95%CI, 1.04-1.42, respectively). A significant association was observed for AF risk with long-chain acylcarnitines: 1.20 (1.06-1.36). Additive interaction of the association between long-chain acylcarnitines and AF by the MediDiet supplemented with extra virgin olive oil (P for additive interaction=.036) and by obesity (P=.022) was observed in an inverse and direct manner, respectively. CONCLUSIONS Among individuals at high cardiovascular risk, elevated long-chain acylcarnitines were associated with a higher risk of incident HF and AF. An intervention with MedDiet+extra-virgin olive oil may reduce AF risk associated with long-chain acylcarnitines. This trial was registered at controlled-trials.com (Identifier: ISRCTN35739639).
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Affiliation(s)
- Miguel Ruiz-Canela
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, Pamplona, Navarra, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.
| | - Marta Guasch-Ferré
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, MA, United States
| | - Cristina Razquin
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, Pamplona, Navarra, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Estefanía Toledo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, Pamplona, Navarra, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo Hernández-Alonso
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Unitat de Nutrició Humana, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Reus, Tarragona, Spain; Institut d'Investigació Sanitària Pere iVirgili, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain
| | - Clary B Clish
- Broad 13Broad Institute and MIT, Harvard University, Cambridge, MA, United States
| | - Jun Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Clemens Wittenbecher
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Courtney Dennis
- Broad 13Broad Institute and MIT, Harvard University, Cambridge, MA, United States
| | - Ángel Alonso-Gómez
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Instituto Sanitario de Investigación de Bioaraba, Servicio Vasco de Salud-Osakidetza, Hospital Universitario de Araba; Universidad del País Vasco UPV/EHU; Vitoria-Gasteiz, Spain
| | - Enrique Almanza-Aguilera
- Unidad de Riesgo Cardiovascular y Nutrición, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Nutrición y Seguridad Alimentaria (INSA-UB), Universidad de Barcelona, Santa Coloma de Gramanet, Barcelona, Spain
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Dolores Corella
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Medicina Preventiva, Universidad de Valencia, Valencia, Spain
| | - Enrique Gómez-Gracia
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Medicina Preventiva, Universidad de Málaga, Málaga, Spain
| | - Ramón Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Medicina Interna, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
| | - Miguel Fiol
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Plataforma de Ensayos Clínicos, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Hospital Universitario Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - José Lapetra
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Medicina de familia, Unidad de Investigación, Distrito Sanitario Atención Primaria Sevilla, Seville, Spain
| | - Lluis Serra-Majem
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Grupo de Investigación de Nutrición, Instituto de Investigación Biomédica y Ciencias de la Salud (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Unidad Clínica de Lípidos, Departamento de Nutrición y Endocrinología, Institut d'Investigacions Biomèdiques Agust Pi i Sunyer (IDIBAPS), Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
| | - Fernando Arós
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Instituto Sanitario de Investigación de Bioaraba, Servicio Vasco de Salud-Osakidetza, Hospital Universitario de Araba; Universidad del País Vasco UPV/EHU; Vitoria-Gasteiz, Spain
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Unitat de Nutrició Humana, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Reus, Tarragona, Spain; Institut d'Investigació Sanitària Pere iVirgili, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division for Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, MA, United States
| | - Miguel Ángel Martínez-González
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, Pamplona, Navarra, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Choy M, Liang W, He J, Fu M, Dong Y, He X, Liu C. Phenotypes of heart failure with preserved ejection fraction and effect of spironolactone treatment. ESC Heart Fail 2022; 9:2567-2575. [PMID: 35587714 PMCID: PMC9288804 DOI: 10.1002/ehf2.13969] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/11/2022] [Accepted: 05/04/2022] [Indexed: 12/03/2022] Open
Abstract
Aims The aims of this study were to explore phenotypes of heart failure with preserved ejection fraction (HFpEF) and evaluate differential effects of spironolactone treatment. Methods and results A swap‐stepwise algorithm was used for variable selection. Latent class analysis based on 10 selected variables was employed in a derivative set of 1540 patients from the TOPCAT trial. Cox proportional hazard models were used to evaluate the prognoses and effects of spironolactone treatment. Three phenotypes of HFpEF were identified. Phenotype 1 was the youngest with low burden of co‐morbidities. Phenotype 2 was the oldest with high prevalence of atrial fibrillation, pacemaker implantation, and hypothyroidism. Phenotype 3 was mostly obese and diabetic with high burden of other co‐morbidities. Compared with phenotype 1, phenotypes 2 (hazard ratio [HR]: 1.46; 95% confidence interval [CI]: 1.14–1.89; P = 0.003) and 3 (HR: 2.35; 95% CI: 1.80–3.07; P < 0.001) were associated with higher risks of the primary composite outcome. Spironolactone treatment was associated with a reduced risk of the primary outcome only in phenotype 1 (HR: 0.63; 95% CI: 0.40–0.98; P = 0.042). Conclusions Three distinct HFpEF phenotypes were identified. Spironolactone treatment could improve clinical outcome in a phenotype of relatively young patients with low burden of co‐morbidities.
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Affiliation(s)
- Manting Choy
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,Heart Failure Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Weihao Liang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,Heart Failure Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiangui He
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,Heart Failure Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Michael Fu
- Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,Heart Failure Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xin He
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,Heart Failure Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,Heart Failure Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Gu G, Wu J, Gao X, Liu M, Jin C, Xu Y. Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction: A meta-analysis. Clin Cardiol 2022; 45:786-793. [PMID: 35544952 PMCID: PMC9286329 DOI: 10.1002/clc.23841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/18/2022] [Accepted: 04/28/2022] [Indexed: 01/10/2023] Open
Abstract
Background Catheter ablation (CA) is an effective treatment for patients with atrial fibrillation (AF). The potential of CA to benefit AF patients with heart failure and preserved ejection fraction (HFpEF) is uncertain. Hypothesis CA may be safe and effective for patients with HFpEF. Methods The Medline, PubMed, Embase, and Cochrane Library databases were searched for studies evaluating CA for AF patients with HFpEF. Results A total of seven trials with 1696 patients were included. Pooled analyses demonstrated similar procedure and fluoroscopy time regarding the use of CA for patients with HFpEF and without HF (weighted mean difference [WMD]: 0.40; 95% confidence interval (CI): −0.01–0.81, p = .05 and [WMD: 0.05; 95% CI: −0.18–0.28, p = .68]). Moreover, CA was effective in maintaining sinus rhythm (SR) in patients with HFpEF and noninferior for patients without HF [risk ratio (RR): 0.92; 95% CI: 0.76–1.10, p = .34). Additionally, CA tended to significantly maintain SR (RR: 4.73; 95% CI: 1.86–12.03, p = .001) and reduce rehospitalization for HF compared with medical therapy (RR: 0.36; 95% CI: 0.19–0.71, p = .003). However, no significant differences were found between two groups regarding the mortality rate (p = .59). Conclusion CA is a potential treatment strategy for patients with HFpEF and demonstrates equivalent efficacy to that of patients without HF. Moreover, the benefits of CA in maintaining SR and reducing rehospitalization of HF patients were significantly better than those of medical therapy. Additional randomized controlled trials are warranted to confirm our results.
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Affiliation(s)
- Gaoyang Gu
- Department of the Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jing Wu
- Department of Nursing College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaofei Gao
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Meijun Liu
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chaolun Jin
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yizhou Xu
- Department of the Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Yu Z, Liang Y, Xiao Z, Wang Y, Bao P, Zhang C, Su E, Li M, Chen X, Qin S, Chen R, Su Y, Ge J. Risk factors of pacing dependence and cardiac dysfunction in patients with permanent pacemaker implantation. ESC Heart Fail 2022; 9:2325-2335. [PMID: 35474306 PMCID: PMC9288795 DOI: 10.1002/ehf2.13918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/25/2022] [Accepted: 03/13/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Right ventricular pacing (RVP) dependence could impair left ventricular ejection fraction (LVEF). This study aimed to illuminate the relationship between RVP proportion and LVEF, as well as disclosing independent predictors of RVP dependence. METHODS AND RESULTS Patients indicated for permanent pacemaker implantation were included (2016-2020). The ventricular pacing lead was placed in right ventricular apex or septum. Pacing mode programming followed universal standard. Electrocardiographic, echocardiographic, and serological parameters were collected. RVP dependence was defined according to its influence on LVEF. This study was of case-control design. Included patients were matched by potentially confounding factors through propensity score matching. A total of 1183 patients were included, and the mean duration of follow-up was 24 months. Percentage of RVP < 80% hardly influenced LVEF; however, LVEF tended to decrease with higher RVP proportion. High degree/complete atrioventricular block (AVB) [odds ratio (OR) = 5.71, 95% confidence interval (CI): 3.66-8.85], atrial fibrillation (AF) (OR = 2.04, 95% CI: 1.47-2.82), percutaneous coronary intervention (PCI) (OR = 2.89, 95% CI: 1.24-6.76), maximum heart rate (HRmax ) < 110 b.p.m. (OR = 2.74, 95% CI: 1.58-4.76), QRS duration > 120 ms (OR = 2.46, 95% CI: 1.42-4.27), QTc interval > 470 ms (OR = 2.01, 95% CI: 1.33-3.05), and pulmonary artery systolic pressure (PASP) > 40 mmHg (OR = 1.93, 95% CI: 1.46-2.56) were proved to predict RVP dependence. CONCLUSIONS High RVP percentage (>80%) indicating RVP dependence significantly correlates with poor prognosis of cardiac function. High degree/complete AVB, AF, ischaemic aetiology, PCI history, HRmax < 110 b.p.m., QRS duration > 120 ms, QTc interval > 470 ms, and PASP > 40 mmHg were verified as independent risk factors of RVP dependence.
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Affiliation(s)
- Ziqing Yu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yixiu Liang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zilong Xiao
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yucheng Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Pei Bao
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Chunyu Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Enyong Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Minghui Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xueying Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shengmei Qin
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Ruizhen Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Department of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JG, Coats AJ, Crespo-Leiro MG, Farmakis D, Gilard M, Heyman S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CS, Lyon AR, McMurray JJ, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GM, Ruschitzka F, Skibelund AK. Guía ESC 2021 sobre el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Méndez-Bailon M, Iguarán-Bermudez R, Formiga-Pérez F, Arévalo Lorido JC, Suárez-Pedreira I, Morales-Rull JL, Serrado-Iglesias A, Llacer-Iborra P, Ormaechea-Gorricho G, Carrasco-Sánchez FJ, Casado-Cerrada J, Andrès E, Diez-Manglano J, Lorenzo-Villalba N, Montero-Pérez-Barquero M. Prognostic Significance of the PROFUND Index on One Year Mortality in Acute Heart Failure: Results from the RICA Registry. J Clin Med 2022; 11:jcm11071876. [PMID: 35407495 PMCID: PMC9000036 DOI: 10.3390/jcm11071876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/17/2022] [Accepted: 03/25/2022] [Indexed: 01/25/2023] Open
Abstract
Background: Heart failure (HF) is a syndrome with high prevalence, mainly affecting elderly patients, where the presence of associated comorbidities is of great importance. Methods: An observational study from a prospective registry was conducted. Patients identified from the National Registry of Heart Failure (RICA), which belongs to the Working Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. The latter is a prospective, multicenter registry that has been active since 2008. It includes individual consecutive patients over 50 years of age with a diagnosis of HF at hospital discharge (acute decompensated or new-onset HF). Results: In total, 5424 patients were identified from the registry. Forty-seven percent were men and mean left ventricular ejection fraction (LVEF) was 51.4%; 1132 had a score of 0 to 2 according to the PROFUND index, 3087 had a score of 3 to 6, and 952 patients had a score of 7 to 10 points. In the sample, 252 patients had a score above 11 points. At the end of the year of follow-up, 61% of the patients died. This mortality increased proportionally as the PROFUND index increased, specifically 75% for patients with PROFUND greater than 11. The Kaplan-Meier survival curve shows that survival at one year progressively decreases as the PROFUND index value increases. Thus, subjects with scores greater than seven (intermediate-high and high-risk) presented the worst survival with a log rank of 0.96 and a p < 0.05. In the regression analysis, we found a higher risk of death from any cause at one year in the group with the highest risk according to the PROFUND index (score greater than 11 points (HR 1.838 (1.410−2.396)). Conclusions: The PROFUND index is a good index for predicting mortality in patients admitted for acute HF, especially in those subjects at intermediate to high risk with scores above seven. Future studies should seek to determine whether the PROFUND index score is simply a prognostic marker or whether it can also be used to make therapeutic decisions for those subjects with very high short-term mortality.
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Affiliation(s)
- Manuel Méndez-Bailon
- Internal Medicine Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.)
| | - Rosario Iguarán-Bermudez
- Internal Medicine Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (M.M.-B.); (R.I.-B.)
| | - Francesc Formiga-Pérez
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain;
| | | | | | - Jose Luis Morales-Rull
- Internal Medicine Department, Hospital Universitario Arnau de Villanova, 25198 Lleida, Spain;
| | | | - Pau Llacer-Iborra
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain;
| | - Gabriela Ormaechea-Gorricho
- Unidad Multidisciplinar de Insuficiencia Cardíaca, Hospital de Clínicas Dr. Manuel Quintela, Montevideo 11600, Uruguay;
| | | | - Jesús Casado-Cerrada
- Internal Medicine Department, Hospital Universitario de Getafe, 28905 Madrid, Spain;
| | - Emmanuel Andrès
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
| | - Jesús Diez-Manglano
- Internal Medicine Department, Hospital Universitario Royo Villanova, 50015 Zaragoza, Spain;
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
- Correspondence:
| | - Manuel Montero-Pérez-Barquero
- Internal Medicine Department, IMIBIC/Hospital Universitario Reina Sofía, Universidad de Córdoba, 14004 Córdoba, Spain;
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Assessing Interplay Between Atrial Fibrillation and Heart Failure in Patients With Cardiac Implantable Electronic Devices. JACC Clin Electrophysiol 2022; 8:194-196. [PMID: 35210076 DOI: 10.1016/j.jacep.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022]
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2022; 24:4-131. [PMID: 35083827 DOI: 10.1002/ejhf.2333] [Citation(s) in RCA: 889] [Impact Index Per Article: 444.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022] Open
Abstract
Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes-Genis (Spain), Michael A. Borger (Germany), Werner Budts (Belgium), Maja Cikes (Croatia), Kevin Damman (Netherlands), Victoria Delgado (Netherlands), Paul Dendale (Belgium), Polychronis Dilaveris (Greece), Heinz Drexel (Austria), Justin Ezekowitz (Canada), Volkmar Falk (Germany), Laurent Fauchier (France), Gerasimos Filippatos (Greece), Alan Fraser (United Kingdom), Norbert Frey (Germany), Chris P. Gale (United Kingdom), Finn Gustafsson (Denmark), Julie Harris (United Kingdom), Bernard Iung (France), Stefan Janssens (Belgium), Mariell Jessup (United States of America), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil S. Lewis (Israel), Francisco Leyva (United Kingdom), AleVs Linhart (Czech Republic), Maja-Lisa Løchen (Norway), Lars H. Lund (Sweden), Donna Mancini (United States of America), Josep Masip (Spain), Davor Milicic (Croatia), Christian Mueller (Switzerland), Holger Nef (Germany), Jens-Cosedis Nielsen (Denmark), Lis Neubeck (United Kingdom), Michel Noutsias (Germany), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Dimitrios J. Richter (Greece), Evgeny Schlyakhto (Russia), Petar Seferovic (Serbia), Michele Senni (Italy), Marta Sitges (Spain), Miguel Sousa-Uva (Portugal), Carlo G. Tocchetti (Italy), Rhian M. Touyz (United Kingdom), Carsten Tschoepe (Germany), Johannes Waltenberger (Germany/Switzerland) All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website www.escardio.org/guidelines For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the guidelines see European Heart Journal online.
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Yang M, Zhang R, Tang H, Li G, Guan X, Yang Y, Sun Y, Xiao X, Yu X, Yin X, Dong Y, Gao L, Xia Y, Yang Y. E/E′ Is a New Independent Predictor of Recovered Ejection Fraction in Patients With Systolic Heart Failure Undergoing Ablation for Atrial Fibrillation. Front Cardiovasc Med 2022; 8:707996. [PMID: 35096987 PMCID: PMC8792464 DOI: 10.3389/fcvm.2021.707996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Aims: Catheter ablation should be considered in patients with atrial fibrillation (AF) and with heart failure (HF) with reduced ejection fraction (EF; HFrEF) to improve survival and reduce heart failure hospitalization. Careful patient selection for AF ablation is key to achieving similar outcome benefits. However, limited data exist regarding predictors of recovered ejection fraction. We aimed to evaluate the predictors of recovered ejection fraction in consecutive patients with HF undergoing AF ablation. Methods and Results: A total of 156 patients [67.3% men, median age 63 (11)] with AF and HF underwent initial catheter ablation between September 2017 and October 2019 in the First Affiliated Hospital of Dalian Medical University. Overall, the percentage of recovered ejection fractions was 72.3%. Recovered EFs were associated with a 39% reduction in all-cause hospitalization compared to non-recovered EFs at the 1-year follow-up [23.8 vs. 62.8 (odds ratio) OR 2.09 (1.40–3.12), P < 0.001]. Univariate analysis for recovered EFs showed that diabetes (P = 0.083), prevalent HF (P = 0.014), prevalent AF (P = 0.051), LVEF (P = 0.022), and E/E′ (P = 0.001) were associated with EF improvement. Multivariate analysis showed that the only independent predictor of EF recovery was E/E′ [OR 1.13 (1.03–1.24); P = 0.011]. A receiver operating characteristic analysis determined that the suitable cut-off value for E/E′ was 15 (sensitivity 38.7%, specificity 89.2%, the area under curve 0.704). Conclusions: Ejection fraction (EF) recovery occurred in 72.3% of patients, associated with a 39% reduction in all-cause hospitalization compared to the non-recovered EFs in our cohort. The only independent predictor of recovered EF was E/E′ < 15 in our series.
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Kanthasamy V, Papageorgiou N, Bajomo T, Monkhouse C, Creta A, Finlay M, Lambiase PD, Moore P, Sporton S, Earley MJ, Schilling RJ, Hayward C, Providência R, Hunter RJ, Chow AA, Muthumala A. Risk factors for developing pacing induced LV dysfunction: Experience from a tertiary centre in the UK. Pacing Clin Electrophysiol 2022; 45:365-373. [PMID: 35023176 DOI: 10.1111/pace.14442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/04/2021] [Accepted: 01/02/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The risk factors for developing pacing induced Left Ventricular dysfunction (LVD) in patients with high burden of right ventricular pacing (RVP) is poorly understood. Therefore, in the present study, we aimed to assess the determinants of pacing induced LVD. METHODS Our data were retrospectively collected from 146 patients with RVP > 40% who underwent generator change (GC) or cardiac resynchronisation therapy (CRT) upgrade between 2016-2019 who had left ventricular ejection fraction (EF) ≥50% at initial implant. RESULTS 75 patients had CRT upgrade due to pacing induced LVD (EF<50%) and 71 patients with preserved LV function (EF ≥50%) had a GC. Primary indication for pacing in both groups was complete heart block. Male predominance (p = 0.008), prior myocardial infarction (MI) (p = 0.001), atrial fibrillation (AF) (p = 0.009), chronic kidney disease (CKD) (p = 0.005), and borderline low systolic function (BLSF) (EF 50-55%) (p = 0.04) were more prevalent in the CRT upgrade group. Presence of AF (OR = 3.05, 95% CI 1.42-6.58; p = 0.004), BLSF (OR = 3.8, 95% CI 1.22-11.8; p = 0.02) and male gender (OR = 2.41, 95% CI 1.14-5.08; p = 0.02) were independent predictors for RVP induced LVD. Age (OR = 1.08, 95% CI 1.02-1.14; p = 0.005) and BLSF (OR = 5.33, 95% CI 1.26-22.5; p = 0.023) were independent predictors of earlier development of LVD after implant. CONCLUSIONS Our results suggested that AF, BLSF and male gender are predictors for development of pacing induced LVD in patients with high RVP burden. LVD can occur at any time after pacemaker implant with BLSF and increasing age associated with earlier development of LVD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Nikolaos Papageorgiou
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE.,Institute of Cardiovascular Science, University College London, UK
| | - Tomi Bajomo
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | | | - Antonio Creta
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Malcolm Finlay
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Pier D Lambiase
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE.,Institute of Cardiovascular Science, University College London, UK
| | - Phil Moore
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Simon Sporton
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Mark J Earley
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Richard J Schilling
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Carl Hayward
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Rui Providência
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Ross J Hunter
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Anthony Aw Chow
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Amal Muthumala
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
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Bertini M, Vitali F, Santini L, Tavoletta V, Giano A, Savarese G, Dello Russo A, Santobuono VE, Mattera A, Lavalle C, Amellone C, Pecora D, Calvanese R, Rapacciuolo A, Campari M, Valsecchi S, Calò L. Implantable defibrillator-detected heart failure status predicts atrial fibrillation occurrence. Heart Rhythm 2022; 19:790-797. [DOI: 10.1016/j.hrthm.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 11/04/2022]
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