Key result
Over a 3-year follow-up, 41.5% of patients with heart failure with preserved ejection fraction and no prior history of atrial fibrillation developed new episodes of the arrhythmia, which was strongly predicted by left atrial stiffness and longitudinal deformation.
Why the study?
The frequency and echocardiographic predictors of atrial fibrillation in patients with heart failure with preserved ejection fraction without prior AF history were not well characterized.
Cohort (n=182)
No
May identify AF risk factors in NEJHF; leaves open echocardiographic predictors pending prospective validation.
Aim. To study the occurrence of atrial fibrillation (AF) in patients with normal ejection fraction heart failure (NEJHF) without AF in anamnesis, and to perform comparative analysis of echocardiographic parameters with the parameters of patients with NEJHF and known AF, as to study independent predictors of AF occurrence in NEJHF. Material and methods. Totally, 182 patients included (105 women) with metabolic syndrome and NEJHF (II-III functional classes by NYHA) at the age 63±12 y. o., with sinus rhythm and no anamnesis of AF (n=118), and with paroxysmal AF (PxAF) in anamnesis (n=28) or persistent (PeAF) in anamnesis (n=36). Results. Among 118 patients with AF in anamnesis, in 49 (41,5%) during 3 years of follow-up, there were cases of PeAF and PxAF. Patients without AF in anamnesis had better relations for left and right ventricles filling comparison (E/e`) under load, index of maximum left atrium volume (LA) (IVLAmax), systolic pressure in pulmonary artery (SPPA) during rest and after exertion, than patients with known episodes of PeAF and PxAF. Patients with PeAF had significantly higher values of the index of post systolic shortening of the left ventricle, rigidity index of LA, IVLAmax, E/e` of RV, interatrial mechanical asynchrony and low values of longitudinal deformation of the LA (LDLA) and velocity parameters of LDLA (VPLDLA). Female sex, systolic arterial pressure, SPPA, IVLAmax, E/e` in load, E/e` of RV, LDLA, longitudinal deformation of the left ventricle and VPLDLA were independent predictors of AF. Conclusion. Increased rigidity, parameters of longitudinal deformation and the volume of LA, as interatrial mechanical asynchrony are strong independent predictors of AF in NEJHF.
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Adamyan et al. (2016) conducted a cohort in Heart failure with preserved ejection fraction (n=182). Echocardiographic parameters (left atrial longitudinal deformation, stiffness, volume) vs. Normal echocardiographic parameters was evaluated on Occurrence of new-onset paroxysmal or persistent atrial fibrillation over 3 years. Over a 3-year follow-up, 41.5% of patients with heart failure with preserved ejection fraction and no prior history of atrial fibrillation developed new episodes of the arrhythmia, which was strongly predicted by left atrial stiffness and longitudinal deformation.
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