BACKGROUND: Since atrial fibrillation (AF) impacts the measurement and interpretation of left ventricular ejection fraction (LVEF), we hypothesized that the outcome in heart failure (HF) with AF and LVEF ≤ 35% would be more strongly associated with neurohormonal measures than LVEF. METHODS AND RESULTS: Cardiac adverse events [CAE; HF progression (HFP), life-threatening arrhythmia (ARR), and cardiac death (CD)] and all-cause mortality (ACM) were recorded prospectively in 954 patients with HF and LVEF ≤ 35%: 852 in sinus rhythm (SR) and 102 in AF. Cox proportional hazard models found that the univariate hazard ratios (HR) for LVEF and the first CAE (primary outcome), HFP, ARR, CD, and ACM were significant in SR (0.933, P < .001, 0.933, P < .001, 0.929, P < .001, 0.916, P < .001, 0.945, P = .001, respectively), but not in AF (1.002, P = .95, 1.060, P = .24, 0.922, P = .15, 0.885, P = .09, 0.932, P = .25). HRs for CAEs and ACM and one or more neurohormonal measures (iodine 123 m-iodobenzylguanidine cardiac parameters, B-type natriuretic peptide, and plasma norepinephrine) were significant in SR and AF. The multivariate models for the first CAE and HFP included neurohormonal measures and LVEF in SR and neurohormonal measures in AF. CONCLUSIONS: In HF with LVEF ≤ 35% with AF, neurohormonal measures, but not LVEF, were related to outcomes.
BACKGROUND: Since atrial fibrillation (AF) impacts the measurement and interpretation of left ventricular ejection fraction (LVEF), we hypothesized that the outcome in heart failure (HF) with AF and LVEF ≤ 35% would be more strongly associated with neurohormonal measures than LVEF. METHODS AND RESULTS: Cardiac adverse events [CAE; HF progression (HFP), life-threatening arrhythmia (ARR), and cardiac death (CD)] and all-cause mortality (ACM) were recorded prospectively in 954 patients with HF and LVEF ≤ 35%: 852 in sinus rhythm (SR) and 102 in AF. Cox proportional hazard models found that the univariate hazard ratios (HR) for LVEF and the first CAE (primary outcome), HFP, ARR, CD, and ACM were significant in SR (0.933, P < .001, 0.933, P < .001, 0.929, P < .001, 0.916, P < .001, 0.945, P = .001, respectively), but not in AF (1.002, P = .95, 1.060, P = .24, 0.922, P = .15, 0.885, P = .09, 0.932, P = .25). HRs for CAEs and ACM and one or more neurohormonal measures (iodine 123 m-iodobenzylguanidine cardiac parameters, B-type natriuretic peptide, and plasma norepinephrine) were significant in SR and AF. The multivariate models for the first CAE and HFP included neurohormonal measures and LVEF in SR and neurohormonal measures in AF. CONCLUSIONS: In HF with LVEF ≤ 35% with AF, neurohormonal measures, but not LVEF, were related to outcomes.
Authors: Roberto M Lang; Michelle Bierig; Richard B Devereux; Frank A Flachskampf; Elyse Foster; Patricia A Pellikka; Michael H Picard; Mary J Roman; James Seward; Jack S Shanewise; Scott D Solomon; Kirk T Spencer; Martin St John Sutton; William J Stewart Journal: J Am Soc Echocardiogr Date: 2005-12 Impact factor: 5.251
Authors: James R Corbett; Olakunle O Akinboboye; Stephen L Bacharach; Jeffrey S Borer; Elias H Botvinick; E Gordon DePuey; Edward P Ficaro; Christopher L Hansen; Milena J Henzlova; Serge Van Kriekinge Journal: J Nucl Cardiol Date: 2006-11 Impact factor: 5.952
Authors: Andrew E Epstein; John P DiMarco; Kenneth A Ellenbogen; N A Mark Estes; Roger A Freedman; Leonard S Gettes; A Marc Gillinov; Gabriel Gregoratos; Stephen C Hammill; David L Hayes; Mark A Hlatky; L Kristin Newby; Richard L Page; Mark H Schoenfeld; Michael J Silka; Lynne Warner Stevenson; Michael O Sweeney; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Jeffrey L Anderson; Christopher E Buller; Mark A Creager; Steven M Ettinger; David P Faxon; Jonathan L Halperin; Loren F Hiratzka; Sharon A Hunt; Harlan M Krumholz; Frederick G Kushner; Bruce W Lytle; Rick A Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel; Lynn G Tarkington; Clyde W Yancy Journal: J Am Coll Cardiol Date: 2008-05-27 Impact factor: 24.094
Authors: Karl Swedberg; Lars G Olsson; Andrew Charlesworth; John Cleland; Peter Hanrath; Michel Komajda; Marco Metra; Christian Torp-Pedersen; Philip Poole-Wilson Journal: Eur Heart J Date: 2005-03-14 Impact factor: 29.983
Authors: Lars G Olsson; Karl Swedberg; Anique Ducharme; Christopher B Granger; Eric L Michelson; John J V McMurray; Margareta Puu; Salim Yusuf; Marc A Pfeffer Journal: J Am Coll Cardiol Date: 2006-04-27 Impact factor: 24.094
Authors: Denis Roy; Mario Talajic; Stanley Nattel; D George Wyse; Paul Dorian; Kerry L Lee; Martial G Bourassa; J Malcolm O Arnold; Alfred E Buxton; A John Camm; Stuart J Connolly; Marc Dubuc; Anique Ducharme; Peter G Guerra; Stefan H Hohnloser; Jean Lambert; Jean-Yves Le Heuzey; Gilles O'Hara; Ole Dyg Pedersen; Jean-Lucien Rouleau; Bramah N Singh; Lynne Warner Stevenson; William G Stevenson; Bernard Thibault; Albert L Waldo Journal: N Engl J Med Date: 2008-06-19 Impact factor: 91.245