Bernadet T Santema1, Mariëlle Kloosterman1, Isabelle C Van Gelder1, Ify Mordi2, Chim C Lang2, Carolyn S P Lam1,3, Stefan D Anker4, John G Cleland5,6, Kenneth Dickstein7,8, Gerasimos Filippatos9, Pim Van der Harst1, Hans L Hillege2, Jozine M Ter Maaten1, Marco Metra10, Leong L Ng11,12, Piotr Ponikowski13,14, Nilesh J Samani11,12, Dirk J Van Veldhuisen1, Aeilko H Zwinderman15, Faiez Zannad16, Kevin Damman1, Peter Van der Meer1, Michiel Rienstra1, Adriaan A Voors1. 1. Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands. 2. School of Medicine Centre for Cardiovascular and Lung Biology, Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK. 3. National Heart Centre Singapore, Hospital Drive, Singapore. 4. Division of Cardiology and Metabolism-Heart Failure, Cachexia & Sarcopenia; Department of Cardiology (CVK), Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine, Charitépl. 1, Berlin, Germany. 5. National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, Sydney St, Chelsea, London, UK. 6. Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow, UK. 7. University of Bergen, Bergen, Norway. 8. Stavanger University Hospital, Gerd-Ragna Bloch Thorsens Gate 8, Stavanger, Norway. 9. National and Kapodistrian University of Athens, School of Medicine & Department of Cardiology, Heart Failure Unit, Athens University Hospital Attikon, 1, Rimini Str, Haidari, 124 62 Athens, Greece. 10. Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazza del Mercato, 15, Brescia, Italy. 11. Department of Cardiovascular Sciences, University of Leicester, Groby Road, Leicester, UK. 12. NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Road Leicester, UK. 13. Department of Heart Diseases, Wroclaw Medical University, Rudolfa Weigla 5, 53-114 Wrocław, Poland. 14. Cardiology Department, 4th Military Hospital, Rudolfa Weigla, 50-981 Wrocław, Poland. 15. Department of Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. 16. INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France.
Abstract
Aims: The clinical correlates and consequences of atrial fibrillation (AF) might be different between heart failure with reduced vs. preserved ejection fraction (HFrEF vs. HFpEF). Biomarkers may provide insights into underlying pathophysiological mechanisms of AF in these different heart failure (HF) phenotypes. Methods and results: We performed a retrospective analysis of the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF), which was an observational cohort. We studied 2152 patients with HFrEF [ejection fraction (EF < 40%)], of which 1419 were in sinus rhythm (SR) and 733 had AF. Another 524 patients with HFpEF (EF ≥50%) were studied, of which 286 in SR and 238 with AF. For the comparison of biomarker profiles, 92 cardiovascular risk markers were measured (Proseek® Olink Cardiovascular III panel). The circulating risk marker pattern observed in HFrEF was different than the pattern in HFpEF: in HFrEF, AF was associated with higher levels of 77 of 92 (84%) risk markers compared to SR; whereas in HFpEF, many more markers were higher in SR than in AF. Over a median follow-up of 21 months, AF was associated with increased mortality risk [multivariable hazard ratio (HR) of 1.27; 95% confidence interval (CI) 1.09-1.48, P = 0.002]; there was no significant interaction between heart rhythm and EF group on outcome. Conclusion: In patients with HFrEF, the presence of AF was associated with a homogeneously elevated cardiovascular risk marker profile. In contrast, in patients with HFpEF, the presence of AF was associated with a more scattered risk marker profile, suggesting differences in underlying pathophysiological mechanisms of AF in these HF phenotypes.
Aims: The clinical correlates and consequences of atrial fibrillation (AF) might be different between heart failure with reduced vs. preserved ejection fraction (HFrEF vs. HFpEF). Biomarkers may provide insights into underlying pathophysiological mechanisms of AF in these different heart failure (HF) phenotypes. Methods and results: We performed a retrospective analysis of the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF), which was an observational cohort. We studied 2152 patients with HFrEF [ejection fraction (EF < 40%)], of which 1419 were in sinus rhythm (SR) and 733 had AF. Another 524 patients with HFpEF (EF ≥50%) were studied, of which 286 in SR and 238 with AF. For the comparison of biomarker profiles, 92 cardiovascular risk markers were measured (Proseek® Olink Cardiovascular III panel). The circulating risk marker pattern observed in HFrEF was different than the pattern in HFpEF: in HFrEF, AF was associated with higher levels of 77 of 92 (84%) risk markers compared to SR; whereas in HFpEF, many more markers were higher in SR than in AF. Over a median follow-up of 21 months, AF was associated with increased mortality risk [multivariable hazard ratio (HR) of 1.27; 95% confidence interval (CI) 1.09-1.48, P = 0.002]; there was no significant interaction between heart rhythm and EF group on outcome. Conclusion: In patients with HFrEF, the presence of AF was associated with a homogeneously elevated cardiovascular risk marker profile. In contrast, in patients with HFpEF, the presence of AF was associated with a more scattered risk marker profile, suggesting differences in underlying pathophysiological mechanisms of AF in these HF phenotypes.
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Authors: Sana M Al-Khatib; Emelia J Benjamin; Christine M Albert; Alvaro Alonso; Cynthia Chauhan; Peng-Sheng Chen; Anne B Curtis; Patrice Desvigne-Nickens; Jennifer E Ho; Carolyn S P Lam; Mark S Link; Kristen K Patton; Margaret M Redfield; Michiel Rienstra; Yves Rosenberg; Renate Schnabel; John A Spertus; Lynne Warner Stevenson; Mellanie True Hills; Adriaan A Voors; Lawton S Cooper; Alan S Go Journal: Circulation Date: 2020-06-08 Impact factor: 29.690