Jolanta M Siller-Matula1, Ladislav Pecen2, Giuseppe Patti3, Markus Lucerna4, Paulus Kirchhof5, Maciej Lesiak6, Kurt Huber7, Freek W A Verheugt8, Irene M Lang9, Giulia Renda10, Renate B Schnabel11, Rolf Wachter12, Dipak Kotecha13, Jean-Marc Sellal14, Miklos Rohla15, Fabrizio Ricci10, Raffaele De Caterina16. 1. Department of Cardiology, Medical University of Vienna, Vienna, Austria; 1st Department of Cardiology, Poznan University of Medical Sciences, Poland. Electronic address: jolanta.siller-matula@meduniwien.ac.at. 2. Institute of Informatics, Academy of Sciences of Czech Republic, Prague, Czech Republic. 3. Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy. 4. Daiichi Sankyo Europe, Munich, Germany. 5. Institute of Cardiovascular Sciences, University of Birmingham and SWBH and UHB NHS Trusts, Birmingham, UK; AFNET, Münster, Germany. 6. 1st Department of Cardiology, Poznan University of Medical Sciences, Poland. 7. 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical School, Vienna, Austria. 8. Emeritus Professor of Cardiology, Amsterdam, The Netherlands. 9. Department of Cardiology, Medical University of Vienna, Vienna, Austria. 10. G. d'Annunzio University of Chieti and Center of Excellence on Aging, CeSI-Met, Italy. 11. Department for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany. 12. Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany; German Center for Cardiovascular Research, partner site, Göttingen, Germany. 13. Institute of Cardiovascular Sciences, University of Birmingham and SWBH and UHB NHS Trusts, Birmingham, UK. 14. Department of Cardiology, University Hospital Nancy, France. 15. 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria. 16. G. d'Annunzio University of Chieti and Center of Excellence on Aging, CeSI-Met, Italy. Electronic address: rdecater@unich.it.
Abstract
BACKGROUND AND OBJECTIVES: To assess thromboembolic and bleeding risks in patients with heart failure (HF) and atrial fibrillation (AF) according to HF type. METHODS: We analyzed 6170 AF patients from the Prevention of thromboembolic events - European Registry in Atrial Fibrillation (PREFER in AF), and categorized patients into: HF with reduced left-ventricular ejection fraction (HFrEF; LVEF < 40%); mid-range EF (HFmrEF; LVEF: 40-49%); lower preserved EF (HFLpEF; LVEF: 50-60%), higher preserved EF (HFHpEF; LVEF > 60%), and no HF. Outcomes were ischemic stroke, major adverse cardiovascular and cerebral events (MACCE) and major bleeding occurring within 1-year. RESULTS: The annual incidence of stroke was linearly and inversely related to LVEF, increasing by 0.054% per each 1% of LVEF decrease (95% CI: 0.013%-0.096%; p = 0.031). Patients with HFHpEF had the highest CHA2DS2-VASc score, but significantly lower stroke incidence than other HF groups (0.65%, compared to HFLpEF 1.30%; HFmrEF 1.71%; HFrEF 1.75%; trend p = 0.014). The incidence of MACCE was also lower in HFHpEF (2.0%) compared to other HF groups (range: 3.8-4.4%; p = 0.001). Age, HF type, and NYHA class were independent predictors of thromboembolic events. Conversely, major bleeding did not significantly differ between groups (p = 0.168). CONCLUSION: Our study in predominantly anticoagulated patients with AF shows that, reduction in LVEF is associated with higher thromboembolic, but not higher bleeding risk. HFHpEF is a distinct and puzzling group, featuring the highest CHA2DS2-VASc score but the lowest residual risk of thromboembolic events, which warrants further investigation.
BACKGROUND AND OBJECTIVES: To assess thromboembolic and bleeding risks in patients with heart failure (HF) and atrial fibrillation (AF) according to HF type. METHODS: We analyzed 6170 AF patients from the Prevention of thromboembolic events - European Registry in Atrial Fibrillation (PREFER in AF), and categorized patients into: HF with reduced left-ventricular ejection fraction (HFrEF; LVEF < 40%); mid-range EF (HFmrEF; LVEF: 40-49%); lower preserved EF (HFLpEF; LVEF: 50-60%), higher preserved EF (HFHpEF; LVEF > 60%), and no HF. Outcomes were ischemic stroke, major adverse cardiovascular and cerebral events (MACCE) and major bleeding occurring within 1-year. RESULTS: The annual incidence of stroke was linearly and inversely related to LVEF, increasing by 0.054% per each 1% of LVEF decrease (95% CI: 0.013%-0.096%; p = 0.031). Patients with HFHpEF had the highest CHA2DS2-VASc score, but significantly lower stroke incidence than other HF groups (0.65%, compared to HFLpEF 1.30%; HFmrEF 1.71%; HFrEF 1.75%; trend p = 0.014). The incidence of MACCE was also lower in HFHpEF (2.0%) compared to other HF groups (range: 3.8-4.4%; p = 0.001). Age, HF type, and NYHA class were independent predictors of thromboembolic events. Conversely, major bleeding did not significantly differ between groups (p = 0.168). CONCLUSION: Our study in predominantly anticoagulated patients with AF shows that, reduction in LVEF is associated with higher thromboembolic, but not higher bleeding risk. HFHpEF is a distinct and puzzling group, featuring the highest CHA2DS2-VASc score but the lowest residual risk of thromboembolic events, which warrants further investigation.
Authors: Giuseppe Ambrosio; A John Camm; Jean-Pierre Bassand; Ramon Corbalan; Gloria Kayani; Erberto Carluccio; Lorenzo G Mantovani; Saverio Virdone; Ajay K Kakkar Journal: ESC Heart Fail Date: 2021-01-12
Authors: Giuseppe Boriani; Marco Vitolo; Igor Diemberger; Marco Proietti; Anna Chiara Valenti; Vincenzo Livio Malavasi; Gregory Y H Lip Journal: Cardiovasc Res Date: 2021-06-16 Impact factor: 13.081
Authors: Gloria M Gager; Georg Gelbenegger; Bernd Jilma; Dirk von Lewinski; Harald Sourij; Ceren Eyileten; Krzysztof Filipiak; Marek Postula; Jolanta M Siller-Matula Journal: Front Cardiovasc Med Date: 2021-07-14