Roopinder K Sandhu1, Stefan H Hohnloser2, Marc A Pfeffer2, Fei Yuan2, Robert G Hart2, Salim Yusuf2, Stuart J Connolly2, Finlay A McAlister2, Jeff S Healey2. 1. From the Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (R.K.S.); Division of Cardiac Electrophysiology, J.W. Goethe University, Frankfurt, Germany (S.H.H.); Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.A.P.); Division of Neurology (R.G.H.), Division of Cardiology (S.Y., S.J.C., J.S.H.), Population Health Research Institute (F.Y.), McMaster University, Hamilton, ON, Canada; The Canadian VIGOUR Center, Edmonton, Alberta, Canada (F.A.M.); and Division of General Internal Medicine, University of Alberta, Edmonton, Canada (F.A.M.). rsandhu2@ualberta.ca. 2. From the Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (R.K.S.); Division of Cardiac Electrophysiology, J.W. Goethe University, Frankfurt, Germany (S.H.H.); Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.A.P.); Division of Neurology (R.G.H.), Division of Cardiology (S.Y., S.J.C., J.S.H.), Population Health Research Institute (F.Y.), McMaster University, Hamilton, ON, Canada; The Canadian VIGOUR Center, Edmonton, Alberta, Canada (F.A.M.); and Division of General Internal Medicine, University of Alberta, Edmonton, Canada (F.A.M.).
Abstract
BACKGROUND AND PURPOSE: Limited data exists regarding the relationship between left ventricular systolic dysfunction (LVSD) and heart failure (HF) symptoms and embolic risk among patients with atrial fibrillation. METHODS:Participants in the Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE) trials with HF, but not randomized to oral anticoagulation, were categorized as having preserved versus reduced ejection fraction. If reduced, LVSD was classified as mild, moderate, or severe. Symptoms were quantified using New York Heart Association class.The primary outcome was a composite of stroke, transient ischemic attack, and systemic embolism. RESULTS: There were 3487 antiplatelet-treated patients with HF at baseline. Of these patients, 969 (46.8%) had HF with preserved ejection fraction and 1103 (53.2%) had HF with reduced ejection fraction. During 3.6 years of mean follow-up, first occurrence of stroke, transient ischemic attack, or systemic embolism occurred in 386 patients.The strongest independent predictors of embolic events were age ≥75 years (hazard ratio 2.55; confidence interval, 1.85-3.53), prior stroke or transient ischemic attack (hazard ratio 2.07; 95% confidence interval, 1.65-2.60), and female sex (hazard ratio 1.37; confidence interval, 1.11-1.69). However, ejection fraction <0.50, degree of LVSD, and New York Heart Association class did not predict embolic events. Patients with HF with preserved ejection fraction exhibited similar risk of embolic events as those with HR with reduced ejection fraction: 4.3% versus 4.4% per 100 person-years (hazard ration 1.01; 95% confidence interval, 0.78-1.31). Risk of embolic events was similar across categories of LVSD (P for trend =0.96) and New York Heart Association class (P for trend =0.57). CONCLUSION: Among HF patients in ACTIVE, neither the presence of LVSD or degree of symptom severity influenced risk of embolic events.
RCT Entities:
BACKGROUND AND PURPOSE: Limited data exists regarding the relationship between left ventricular systolic dysfunction (LVSD) and heart failure (HF) symptoms and embolic risk among patients with atrial fibrillation. METHODS:Participants in the Atrial FibrillationClopidogrel Trial With Irbesartan for Prevention of Vascular Events (ACTIVE) trials with HF, but not randomized to oral anticoagulation, were categorized as having preserved versus reduced ejection fraction. If reduced, LVSD was classified as mild, moderate, or severe. Symptoms were quantified using New York Heart Association class.The primary outcome was a composite of stroke, transient ischemic attack, and systemic embolism. RESULTS: There were 3487 antiplatelet-treated patients with HF at baseline. Of these patients, 969 (46.8%) had HF with preserved ejection fraction and 1103 (53.2%) had HF with reduced ejection fraction. During 3.6 years of mean follow-up, first occurrence of stroke, transient ischemic attack, or systemic embolism occurred in 386 patients.The strongest independent predictors of embolic events were age ≥75 years (hazard ratio 2.55; confidence interval, 1.85-3.53), prior stroke or transient ischemic attack (hazard ratio 2.07; 95% confidence interval, 1.65-2.60), and female sex (hazard ratio 1.37; confidence interval, 1.11-1.69). However, ejection fraction <0.50, degree of LVSD, and New York Heart Association class did not predict embolic events. Patients with HF with preserved ejection fraction exhibited similar risk of embolic events as those with HR with reduced ejection fraction: 4.3% versus 4.4% per 100 person-years (hazard ration 1.01; 95% confidence interval, 0.78-1.31). Risk of embolic events was similar across categories of LVSD (P for trend =0.96) and New York Heart Association class (P for trend =0.57). CONCLUSION: Among HF patients in ACTIVE, neither the presence of LVSD or degree of symptom severity influenced risk of embolic events.
Authors: Line Melgaard; Anders Gorst-Rasmussen; Lars Hvilsted Rasmussen; Gregory Y H Lip; Torben Bjerregaard Larsen Journal: PLoS One Date: 2016-03-25 Impact factor: 3.240
Authors: Azmil H Abdul-Rahim; Ana-Cristina Perez; Rachael L MacIsaac; Pardeep S Jhund; Brian L Claggett; Peter E Carson; Michel Komajda; Robert S McKelvie; Michael R Zile; Karl Swedberg; Salim Yusuf; Marc A Pfeffer; Scott D Solomon; Gregory Y H Lip; Kennedy R Lees; John J V McMurray Journal: Eur Heart J Date: 2017-03-07 Impact factor: 29.983
Authors: Serdar Tütüncü; Marcus Honold; Kerstin Koehler; Oliver Deckwart; Friedrich Koehler; Karl Georg Haeusler Journal: ESC Heart Fail Date: 2020-03-12