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Persistent atrial fibrillation in heart failure with preserved ejection fraction: Prognostic relevance and association with clinical, imaging and invasive haemodynamic parameters
Author(s) -
Schönbauer Robert,
Duca Franz,
Kammerlander Andreas A.,
Aschauer Stefan,
Binder Christina,
ZotterTufaro Caroline,
Koschutnik Matthias,
Fiedler Lukas,
Roithinger Franz Xaver,
Loewe Christian,
Hengstenberg Christian,
Bonderman Diana,
Mascherbauer Julia
Publication year - 2020
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.13184
Subject(s) - medicine , cardiology , atrial fibrillation , heart failure , interquartile range , ejection fraction , heart failure with preserved ejection fraction , coronary artery disease , population , left atrial enlargement , proportional hazards model , sinus rhythm , environmental health
Background Atrial fibrillation (AF) is a frequent finding in HFpEF. However, its association with invasive haemodynamics, imaging parameters and outcome in HFpEF is not well established. Furthermore, the relevance of AF subtype with regard to outcome is unclear. This study sought to investigate the prognostic impact of paroxysmal and persistent AF in a well‐defined heart failure with preserved ejection fraction (HFpEF) population. Materials and methods Between 2010 and 2016, 254 HFpEF patients were prospectively enrolled. All patients underwent echocardiography as well as left and right heart catheterization. Patients without contraindications underwent CMR including T1 mapping. Follow‐up and outcome data were collected. Patients with significant coronary artery disease were excluded. Results A total of 153 patients (60%) suffered from AF, 119 (47%) had persistent and 34 (13%) had paroxysmal AF. By multiple logistic regression analysis, persistent AF was independently associated with NT‐proBNP ( P = .003), NYHA functional class ( P = .040), left and right atrial size ( P = .022 and <.001, respectively), cardiac output ( P = .002) and COPD ( P = .034). After a median follow‐up of 23 months (interquartile range 5‐48), 92 patients (36%) reached the primary end point defined as hospitalization for heart failure or cardiovascular death. By multivariate Cox regression analysis, only persistent AF ( P = .005) and six‐minute walk distance ( P = .011) were independently associated with the primary end point. Conclusions Sixty percent of our HFpEF patients suffered from AF. Persistent but not paroxysmal AF was strongly associated with event‐free survival and was independently related to NYHA functional class, serum NT‐proBNP, atrial size, cardiac ouput and presence of COPD.