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The prognostic impact of mechanical atrial dysfunction and atrial fibrillation in heart failure with preserved ejection fraction
European Heart Journal - Cardiovascular Imaging ( IF 6.2 ) Pub Date : 2021-10-09 , DOI: 10.1093/ehjci/jeab222
Jerremy Weerts 1 , Arantxa Barandiarán Aizpurua 1 , Michiel T H M Henkens 1 , Aurore Lyon 2 , Manouk J W van Mourik 1 , Mathijs R A A van Gemert 1 , Anne Raafs 1 , Sandra Sanders-van Wijk 3 , Antoni Bayés-Genís 4 , Stephane R B Heymans 1, 5 , Harry J G M Crijns 1 , Hans-Peter Brunner-La Rocca 1 , Joost Lumens 2 , Vanessa P M van Empel 1 , Christian Knackstedt 1
Affiliation  

Aims This study assessed the prognostic implications of mechanical atrial dysfunction in heart failure with preserved ejection fraction (HFpEF) patients with different stages of atrial fibrillation (AF) in detail. Methods and results HFpEF patients (n = 258) systemically underwent an extensive clinical characterization, including 24-h Holter monitoring and speckle-tracking echocardiography. Patients were categorized according to rhythm and stages of AF: 112 with no history of AF (no AF), 56 with paroxysmal AF (PAF), and 90 with sustained (persistent/permanent) AF (SAF). A progressive decrease in mechanical atrial function was seen: left atrial reservoir strain (LASr) 30.5 ± 10.5% (no AF), 22.3 ± 10.5% (PAF), and 13.9 ± 7.8% (SAF), P < 0.001. Independent predictors for lower LASr values were AF, absence of chronic obstructive pulmonary disease, higher N-terminal-pro hormone B-type natriuretic peptide, left atrial volume index, and relative wall thickness, lower left ventricular global longitudinal strain, and echocardiographic signs of elevated left ventricular filling pressure. LASr was an independent predictor of adverse outcome (hazard ratio per 1% decrease =1.049, 95% confidence interval 1.014–1.085, P = 0.006), whereas AF was not when the multivariable model included LASr. Moreover, LASr mediated the adverse outcome associated with AF in HFpEF (P = 0.008). Conclusion Mechanical atrial dysfunction has a possible greater prognostic role in HFpEF compared to AF status alone. Mechanical atrial dysfunction is a predictor of adverse outcome independently of AF presence or stage, and may be an underlying mechanism (mediator) for the worse outcome associated with AF in HFpEF. This may suggest mechanical atrial dysfunction plays a crucial role in disease progression in HFpEF patients with AF, and possibly also in HFpEF patients without AF.

中文翻译:

机械性心房功能障碍和心房颤动对射血分数保留心力衰竭预后的影响

目的 本研究详细评估了机械性心房功能障碍对不同阶段心房颤动 (AF) 的射血分数保留 (HFpEF) 患者的预后影响。方法和结果 HFpEF 患者 (n = 258) 全身接受了广泛的临床特征,包括 24 小时动态心电图监测和斑点追踪超声心动图。根据 AF 的节律和分期对患者进行分类:112 名无 AF 病史(无 AF),56 名患有阵发性 AF(PAF),90 名患有持续性(持续性/永久性)AF(SAF)。观察到机械心房功能逐渐下降:左心房储层应变 (LASr) 30.5 ± 10.5% (无 AF)、22.3 ± 10.5% (PAF) 和 13.9 ± 7.8% (SAF),P <; 0.001。较低 LASr 值的独立预测因子是 AF,无慢性阻塞性肺疾病、较高的 N-末端前激素 B 型利钠肽、左心房容积指数和相对壁厚、较低的左心室整体纵向应变和左心室充盈压升高的超声心动图征象。LASr 是不良结局的独立预测因子(每降低 1% 的风险比 = 1.049,95% 置信区间 1.014-1.085,P = 0.006),而当多变量模型包括 LASr 时,AF 则不是。此外,LASr 介导了 HFpEF 中与 AF 相关的不良结果(P = 0.008)。结论与单独的 AF 状态相比,机械性心房功能障碍在 HFpEF 中可能具有更大的预后作用。机械性心房功能障碍是不良结果的预测因子,与 AF 存在或阶段无关,并且可能是 HFpEF 中与 AF 相关的更差结果的潜在机制(中介)。这可能表明机械性心房功能障碍在 HFpEF 合并 AF 患者的疾病进展中起关键作用,也可能在没有 AF 的 HFpEF 患者中起关键作用。
更新日期:2021-10-09
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