Key result
An increased ratio of diastolic to arterial elastance (Ed/Ea) was independently associated with higher all-cause mortality in HFpEF patients with sinus rhythm (HR 1.835), but not in those with atrial fibrillation.
Why the study?
The prognostic impact of Ed/Ea, an afterload-integrated diastolic index reflecting left atrial pressure overload, was unclear when comparing HFpEF patients with and without AF.
Does the afterload-integrated diastolic index (Ed/Ea) predict all-cause mortality in elderly patients with heart failure with preserved ejection fraction with and without atrial fibrillation?
Observational (n=552)
Yes
Does the afterload-integrated diastolic index (Ed/Ea) predict all-cause mortality in elderly patients with heart failure with preserved ejection fraction with and without atrial fibrillation?
The afterload-integrated diastolic index (Ed/Ea) is a useful prognostic marker for all-cause mortality in elderly HFpEF patients with sinus rhythm, but its prognostic value is diminished in those with atrial fibrillation.
May refine prognosis in HFpEF with sinus rhythm; leaves open therapeutic implications and value in atrial fibrillation.
OBJECTS: We aimed to clarify the differences in the of the ratio of diastolic elastance (Ed) to arterial elastance (Ea), [Ed/Ea=(E/e')/(0.9×systolic blood pressure)], anafterload-integrateddiastolic index that reflects left atrial pressure overload, on prognosis between patients with heart failure with preserved ejection fraction (HFpEF) with and without atrial fibrillation (AF). METHODS: We studied 552 HFpEF patients hospitalized for acute decompensated heart failure (sinus rhythm/AF:352/200).Blood testing and transthoracic echocardiography were performed before discharge. Primary endpoint was all-cause mortality after discharge. RESULTS: During a median follow-up of 508 days, 88 patients (sinus rhythm/AF: 54/34) had all-cause mortality. In the subgroup with sinus rhythm, but not AF, Ed/Ea was significantly higher in patients with than without all-cause mortality. In a multivariate Cox hazard analysis, Ed/Ea was significantly associated with all-cause mortality independent of N-terminal pro-brain natriuretic peptide level in patients with sinus rhythm, but not with AF. CONCLUSIONS: Ed/Ea providedlesser important information for predicting all-cause mortality in HFpEF patients with AF than with sinus rhythm. The prognostic risk factors may differ between elderly HFpEF patients with and without AF.
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A 2021 study conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=552). Ratio of diastolic elastance to arterial elastance (Ed/Ea) vs. Lower Ed/Ea ratio was evaluated on All-cause mortality (HR 1.835, 95% CI 1.019-3.305, p=0.043). An increased ratio of diastolic to arterial elastance (Ed/Ea) was independently associated with higher all-cause mortality in HFpEF patients with sinus rhythm (HR 1.835), but not in those with atrial fibrillation.
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