Stefania Paolillo1, Piergiuseppe Agostoni2, Daniele Masarone3, Ugo Corrà4, Claudio Passino5, Domenico Scrutinio6, Michele Correale7, Gaia Cattadori8, Marco Metra9, Davide Girola10, Massimo F Piepoli11, Elisabetta Salvioni8, Marta Giovannardi8, Annamaria Iorio12, Michele Emdin13, Rosa Raimondo14, Federica Re15, Mariantonietta Cicoira16, Romualdo Belardinelli17, Marco Guazzi18, Francesco Clemenza19, Gianfranco Parati20, Angela B Scardovi21, Andrea Di Lenarda22, Rocco La Gioia6, Maria Frigerio10, Carlo Lombardi7, Paola Gargiulo23, Gianfranco Sinagra12, Giuseppe Pacileo3, Pasquale Perrone-Filardi1, Giuseppe Limongelli3. 1. Department of Advanced Biomedical Sciences, "Federico II" University, Napoli, Italy. 2. Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Università di Milano, Milano, Italy. Electronic address: piergiuseppe.agostoni@unimi.it. 3. Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy. 4. Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy. 5. Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Scuola Superiore S. Anna, Pisa, Italy. 6. Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy. 7. Department of Cardiology, University of Foggia, Foggia, Italy. 8. Centro Cardiologico Monzino, IRCCS, Milano, Italy. 9. Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. 10. Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda-A.O. Niguarda, Milano, Italy. 11. UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy. 12. Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy. 13. Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy. 14. Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Dipartimento di Medicina e Riabilitazione Cardiorespiratoria Unità Operativa di Cardiologia Riabilitativa, Tradate, Varese, Italy. 15. Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy. 16. Section of Cardiology, Department of Medicine, University of Verona, Italy. 17. Cardiologia Riabilitativa, Azienda Ospedali Riuniti, Ancona, Italy. 18. Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy. 19. Heart Failure Unit, ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy. 20. Department of Health Science, University of Milano Bicocca & Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, Milano, Italy. 21. Cardiology Division, Santo Spirito Hospital, Roma, Italy. 22. Centro Cardiovascolare, Azienda per i Servizi Sanitari no. 1, Trieste, Italy. 23. SDN Foundation, Institute of Diagnostic and Nuclear Development, Napoli, Italy.
Abstract
BACKGROUND: Atrial fibrillation (AF) is common in heart failure (HF). It is unclear whether AF has an independent prognostic role in HF. The aim of the present study was to assess the prognostic role of AF in HF patients with reduced ejection fraction (EF). METHODS: HF patients were followed in 17 centers for 3.15years (1.51-5.24). Study endpoints were the composite of cardiovascular (CV) death and heart transplant (HTX) and all-cause death. Data analysis was performed considering the entire population and a 1 to 1 match between sinus rhythm (SR) and AF patients. Match process was done for age±5, gender, left ventricle EF±5, peakVO2±3 (ml/min/kg) and recruiting center. RESULTS: A total of 3447 patients (SR=2882, AF=565) were included in the study. Considering the entire population, CV death and HTX occurred in 114 (20%) AF vs. 471 (16%) SR (p=0.026) and all-cause death in 130 (23%) AF vs. 554 (19.2%) SR patients (p=0.039). At univariable Cox analysis, AF was significantly related to prognosis. Applying a multivariable model based on all variables significant at univariable analysis (EF, peakVO2, ventilation/carbon dioxide relationship slope, sodium, kidney function, hemoglobin, beta-blockers and digoxin) AF was no longer associated with adverse outcomes. Matching procedure resulted in 338 couples. CV death and HTX occurred in 63 (18.6%) AF vs. 74 (21.9%) SR (p=0.293) and all-cause death in 71 (21%) AF vs. 80 (23.6%) SR (p=0.406), with no survival differences between groups. CONCLUSION: In systolic HF AF is a marker of disease severity but not an independent prognostic indicator.
BACKGROUND:Atrial fibrillation (AF) is common in heart failure (HF). It is unclear whether AF has an independent prognostic role in HF. The aim of the present study was to assess the prognostic role of AF in HF patients with reduced ejection fraction (EF). METHODS: HF patients were followed in 17 centers for 3.15years (1.51-5.24). Study endpoints were the composite of cardiovascular (CV) death and heart transplant (HTX) and all-cause death. Data analysis was performed considering the entire population and a 1 to 1 match between sinus rhythm (SR) and AFpatients. Match process was done for age±5, gender, left ventricle EF±5, peakVO2±3 (ml/min/kg) and recruiting center. RESULTS: A total of 3447 patients (SR=2882, AF=565) were included in the study. Considering the entire population, CV death and HTX occurred in 114 (20%) AF vs. 471 (16%) SR (p=0.026) and all-cause death in 130 (23%) AF vs. 554 (19.2%) SR patients (p=0.039). At univariable Cox analysis, AF was significantly related to prognosis. Applying a multivariable model based on all variables significant at univariable analysis (EF, peakVO2, ventilation/carbon dioxide relationship slope, sodium, kidney function, hemoglobin, beta-blockers and digoxin) AF was no longer associated with adverse outcomes. Matching procedure resulted in 338 couples. CV death and HTX occurred in 63 (18.6%) AF vs. 74 (21.9%) SR (p=0.293) and all-cause death in 71 (21%) AF vs. 80 (23.6%) SR (p=0.406), with no survival differences between groups. CONCLUSION: In systolic HF AF is a marker of disease severity but not an independent prognostic indicator.
Authors: Lorenzo Gigli; Pietro Ameri; Gianmarco Secco; Gabriele De Blasi; Roberta Miceli; Alessandra Lorenzoni; Francesco Torre; Francesco Chiarella; Claudio Brunelli; Marco Canepa Journal: World J Cardiol Date: 2016-11-26