TY - JOUR
T1 - Right Heart Dysfunction in Heart Failure With Preserved Ejection Fraction
T2 - The Impact of Atrial Fibrillation
AU - Gorter, Thomas M.
AU - van Melle, Joost P.
AU - Rienstra, Michiel
AU - Borlaug, Barry A.
AU - Hummel, Yoran M.
AU - van Gelder, Isabelle C.
AU - Hoendermis, Elke S.
AU - Voors, Adriaan A.
AU - van Veldhuisen, Dirk J.
AU - Lam, Carolyn S.P.
N1 - Publisher Copyright:
© 2018 The Authors
PY - 2018/3
Y1 - 2018/3
N2 - Background: Right ventricular (RV) dysfunction and atrial fibrillation (AF) frequently coexist in heart failure with preserved ejection fraction (HFpEF). The mechanisms underlying the association between AF and RV dysfunction are incompletely understood. Methods and Results: We identified 102 patients. RV function was assessed with the use of multiple echocardiographic parameters, and dysfunction was present if ≥2 parameters were below the recommended cutoffs. RV function, right atrial (RA) reservoir strain, and RA emptying fraction were compared between AF and sinus rhythm. We included 91 patients with sufficient echocardiographic quality: 45 (50%) had no history of AF, 14 (15%) had earlier AF while in sinus rhythm, and 32 (35%) had current AF. The prevalence of RV dysfunction varied across subgroups (never AF, earlier AF, and current AF: 20%, 43% and 63%, respectively; P =.001). AF was associated with RV dysfunction (odds ratio [OR] 4.70 [95% confidence interval [CI] 1.82–12.1]; P =.001) independently from pulmonary pressures. In patients in sinus rhythm with earlier AF, RA emptying fraction was lower compared with patients without AF history (41 vs 60%; P =.002). Earlier AF was also associated with reduced RA reservoir strain (OR 4.57 [95% CI 1.05–19.9]; P =.04) independently from RV end-diastolic pressure. Conclusions: Atrial fibrillation is strongly related to reduced RV and RA function in HFpEF independently from pulmonary pressures.
AB - Background: Right ventricular (RV) dysfunction and atrial fibrillation (AF) frequently coexist in heart failure with preserved ejection fraction (HFpEF). The mechanisms underlying the association between AF and RV dysfunction are incompletely understood. Methods and Results: We identified 102 patients. RV function was assessed with the use of multiple echocardiographic parameters, and dysfunction was present if ≥2 parameters were below the recommended cutoffs. RV function, right atrial (RA) reservoir strain, and RA emptying fraction were compared between AF and sinus rhythm. We included 91 patients with sufficient echocardiographic quality: 45 (50%) had no history of AF, 14 (15%) had earlier AF while in sinus rhythm, and 32 (35%) had current AF. The prevalence of RV dysfunction varied across subgroups (never AF, earlier AF, and current AF: 20%, 43% and 63%, respectively; P =.001). AF was associated with RV dysfunction (odds ratio [OR] 4.70 [95% confidence interval [CI] 1.82–12.1]; P =.001) independently from pulmonary pressures. In patients in sinus rhythm with earlier AF, RA emptying fraction was lower compared with patients without AF history (41 vs 60%; P =.002). Earlier AF was also associated with reduced RA reservoir strain (OR 4.57 [95% CI 1.05–19.9]; P =.04) independently from RV end-diastolic pressure. Conclusions: Atrial fibrillation is strongly related to reduced RV and RA function in HFpEF independently from pulmonary pressures.
KW - Atrial fibrillation
KW - HFpEF
KW - Right ventricular dysfunction
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U2 - 10.1016/j.cardfail.2017.11.005
DO - 10.1016/j.cardfail.2017.11.005
M3 - Article
C2 - 29197548
AN - SCOPUS:85043586479
SN - 1071-9164
VL - 24
SP - 177
EP - 185
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 3
ER -