Effect of systolic dysfunction and elevated left ventricular end diastolic pressure on 3‐year clinical outcomes in patients with atrial fibrillation

HyeYon Yu; Jihun Ahn

doi:10.1111/echo.15216

October 1, 2021Echocardiography

Effect of systolic dysfunction and elevated left ventricular end diastolic pressure on 3‐year clinical outcomes in patients with atrial fibrillation

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Why the study?

While systolic and diastolic dysfunctions relate to adverse outcomes in sinus rhythm, their prognostic significance in persistent AF remains unclear.

Does reduced ejection fraction or elevated LVEDP predict adverse clinical outcomes in patients with persistent atrial fibrillation?

Structured PICO

Does reduced ejection fraction or elevated LVEDP predict adverse clinical outcomes in patients with persistent atrial fibrillation?

P

Population

114 consecutive patients with persistent atrial fibrillation (AF) who underwent measurement of LVEDP

I

Intervention

Reduced ejection fraction (LVEF < 50%)

C

Comparator

Preserved ejection fraction (LVEF ≥ 50%) with or without elevated LVEDP (>15 mm Hg)

O

Outcome

3-year clinical outcomes including heart failure (HF) hospitalization and incidence of AF with rapid ventricular rhythm (RVR)hard clinical

In patients with persistent atrial fibrillation, systolic dysfunction (LVEF < 50%) is a strong predictor of heart failure hospitalization, whereas elevated LVEDP in those with preserved EF is not associated with adverse mid-term outcomes.

Implication

Supports targeted HF monitoring for reduced EF in persistent AF; leaves open LVEDP's independent prognostic value.

Abstract

OBJECTIVES: Systolic and diastolic dysfunctions are related to adverse clinical outcomes in patients with sinus rhythm. The aim of this study was to clarify the prognostic significance of systolic and diastolic dysfunctions in patients with persistent atrial fibrillation (AF). METHODS: We evaluated the data of 114 consecutive patients with persistent AF who underwent measurement of LVEDP at our hospital between March 1, 2011 and December 31, 2014. The patients were divided into two groups according to the left ventricular ejection fraction (LVEF): LVEF < 50 (reduced ejection fraction, REF group) and LVEF ≥50 (preserved EF, PEF group). The PEF group was further divided into two subgroups according to the left ventricular end-diastolic filling pressure (LVEDP): LVEDP > 15 mm Hg and LVEDP ≤ 15 mm Hg subgroups. The 3-year clinical outcomes were compared between the PEF and REF groups and the LVEDP ≥15 mm Hg and LVEDP < 15 mm Hg groups. RESULTS: During the 3-year follow-up period, the rate of heart failure (HF) hospitalization and incidence of AF with rapid ventricular rhythm (RVR) were higher in the REF group than in the PEF group. Multivariate analysis revealed that REF was the only significant predictor of HF hospitalization (hazard ratio, 4.71; 95% confidence interval, 1.48-15.02; p = 0.009). CONCLUSIONS: Our mid-term follow-up data demonstrated that systolic dysfunction was an important predictor of HF hospitalization in patients with AF. However, elevated LVEDP may not be associated with adverse mid-term clinical outcomes in patients without systolic dysfunction.