Thomas M Gorter1, Joost P van Melle2, Michiel Rienstra2, Barry A Borlaug3, Yoran M Hummel2, Isabelle C van Gelder2, Elke S Hoendermis2, Adriaan A Voors2, Dirk J van Veldhuisen2, Carolyn S P Lam4. 1. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: tm.gorter@umcg.nl. 2. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 3. Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota. 4. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Cardiology, National Heart Center Singapore, Singapore Duke-NUS Graduate Medical School, Singapore.
Abstract
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.
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.
Authors: Hongju Zhang; Edward A El-Am; Jeremy J Thaden; Sorin V Pislaru; Christopher G Scott; Chayakrit Krittanawong; Anwar A Chahal; Thomas J Breen; Mackram F Eleid; Rowlens M Melduni; Kevin L Greason; Robert B McCully; Maurice Enriquez-Sarano; Jae K Oh; Patricia A Pellikka; Vuyisile T Nkomo Journal: Heart Date: 2019-08-22 Impact factor: 5.994
Authors: Yogesh N V Reddy; Masaru Obokata; Frederik H Verbrugge; Grace Lin; Barry A Borlaug Journal: J Am Coll Cardiol Date: 2020-09-01 Impact factor: 24.094
Authors: C Bening; V L Sales; K Alhussini; D Radakovic; R Cris Benitez; N Madrahimov; D Keller; R Leyh Journal: BMC Cardiovasc Disord Date: 2021-03-05 Impact factor: 2.298
Authors: Prathap Kanagala; Jayanth R Arnold; Anvesha Singh; Jamal N Khan; Gaurav S Gulsin; Pankaj Gupta; Iain B Squire; Leong L Ng; Gerry P McCann Journal: Int J Cardiovasc Imaging Date: 2020-07-31 Impact factor: 2.357