What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure with preserved ejection fraction (HFpEF) (n=136). Intervention: Atrial fibrillation vs. Sinus rhythm. Primary outcome: Composite of HF hospitalisation or all-cause mortality (p=0.451).

February 7, 2024BMC Cardiovascular DisordersOpen Access

Is atrial fibrillation in HFpEF a distinct phenotype? Insights from multiparametric MRI and circulating biomarkers

Q: What are the key findings of this study?

Atrial fibrillation in HFpEF altered cardiac mechanics and biomarkers but did not significantly worsen the composite outcome of heart failure hospitalization or death compared to sinus rhythm.

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Key result

AF in HFpEF alters cardiac mechanics but does not worsen major events versus sinus rhythm.

P=0.451
n=136

Why the study?

There is limited understanding of whether the coexistence of HFpEF and AF is associated with distinct alterations in myocardial remodelling and mechanics.

Does the presence of atrial fibrillation in HFpEF represent a distinct phenotype with different clinical outcomes compared to sinus rhythm?

Study Design

Type

Observational (n=136)

Multicenter

Structured PICO

Does the presence of atrial fibrillation in HFpEF represent a distinct phenotype with different clinical outcomes compared to sinus rhythm?

Population

136 adults with heart failure with preserved ejection fraction (HFpEF) defined as LV EF ≥ 50% on TTE, mean age 70-76 years, ~50% female. Key exclusions: myocardial infarction in previous 6 months, possible cardiomyopathy or constrictive pericarditis, severe valve or pulmonary disease, eGFR < 30 ml/min/1.73m2.

Intervention

Presence of atrial fibrillation (AF) (n=61)

Comparator

Sinus rhythm (SR) (n=75)

Outcome

Composite of heart failure hospitalisation or all-cause mortality at a median of 8.5 years follow-upcomposite

Main Result

Absolute Event Rate: 73.8% vs 65.3%

p-value: p=0.451

In patients with HFpEF, the presence of atrial fibrillation is associated with distinct structural, functional, and biomarker profiles, but does not independently drive worse long-term clinical outcomes compared to sinus rhythm.

Limitations

Modest sample size from a single centre
Differences in baseline characteristics between the AF and SR groups
Only 96 participants had parametric mapping performed
Unable to monitor change in AF status during follow up or assess the impact of AF burden
Relatively small number of plasma fibroinflammatory biomarkers assessed

Implication

AF in HFpEF warrants no change in outcome expectations; hypothesis-generating for mechanics and biomarkers as intervention targets.

Abstract

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) frequently co-exist. There is a limited understanding on whether this coexistence is associated with distinct alterations in myocardial remodelling and mechanics. We aimed to determine if patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) represent a distinct phenotype. METHODS: In this secondary analysis of adults with HFpEF (NCT03050593), participants were comprehensively phenotyped with stress cardiac MRI, echocardiography and plasma fibroinflammatory biomarkers, and were followed for the composite endpoint (HF hospitalisation or death) at a median of 8.5 years. Those with AF were compared to sinus rhythm (SR) and unsupervised cluster analysis was performed to explore possible phenotypes. RESULTS: , p < 0.001), lower LA ejection fraction (EF) (31 ± 15 vs. 51 ± 12%, p < 0.001), worse left ventricular (LV) systolic function (LVEF 63 ± 8 vs. 68 ± 8%, p = 0.002; global longitudinal strain 13.6 ± 2.9 vs. 14.7 ± 2.4%, p = 0.003) but higher LV peak early diastolic strain rates (0.73 ± 0.28 vs. 0.53 ± 0.17 1/s, p < 0.001). The AF group had higher levels of syndecan-1, matrix metalloproteinase-2, proBNP, angiopoietin-2 and pentraxin-3, but lower level of interleukin-8. No difference in clinical outcomes was observed between the groups. Three distinct clusters were identified with the poorest outcomes (Log-rank p = 0.029) in cluster 2 (hypertensive and fibroinflammatory) which had equal representation of SR and AF. CONCLUSIONS: Presence of AF in HFpEF is associated with cardiac structural and functional changes together with altered expression of several fibro-inflammatory biomarkers. Distinct phenotypes exist in HFpEF which may have differing clinical outcomes.

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Cite This Study

Dattani et al. (2024) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=136). Atrial fibrillation vs. Sinus rhythm was evaluated on Composite of HF hospitalisation or all-cause mortality (p=0.451). Atrial fibrillation in HFpEF altered cardiac mechanics and biomarkers but did not significantly worsen the composite outcome of heart failure hospitalization or death compared to sinus rhythm.

synapsesocial.com/papers/6a0889e6df3db87398109eaf https://doi.org/10.1186/s12872-024-03734-0