Clinical Investigation
Impact of Atrial Fibrillation in Heart Failure With Normal Ejection Fraction: A Clinical and Echocardiographic Study

https://doi.org/10.1016/j.cardfail.2007.04.014Get rights and content

Abstract

Background

The clinical significance of atrial fibrillation (AF) in heart failure with normal ejection fraction (HFNEF) remains undetermined.

Methods and Results

We compared the clinical and echocardiographic characteristics among 238 patients hospitalized for HF. Using the cutoff of left ventricular EF of 50%, there were 146 patients with HFNEF (AF = 42) and 92 with systolic HF (AF = 30). When compared among HFNEF, the New York Heart Association (NYHA) class (2.61 ± 0.51 versus 2.21 ± 0.46; P < .05), 6-minute walk distance (279.7 ± 66.0 versus 338.0 ± 86.1 m; P < .01), quality of life score (26.1 ± 14.3 versus 19.5 ± 10.3; P < .05), and previous HF hospitalization were significantly worse in the AF group. These variables were significantly better in HFNEF than systolic HF with sinus rhythm, but the differences were not detected among those with AF. Patients with HFNEF and AF were associated with more severe diastolic dysfunction when compared to sinus rhythm. With a median follow-up of 10.5 months, the proportion of HFNEF patients in AF with recurrent HF hospitalization or death was significantly higher than those in sinus rhythm (28.6% versus 10.6%; P < .01). Both AF and restrictive diastolic dysfunction were independent predictors of HF hospitalization or death in HFNEF.

Conclusion

Patients with HFNEF and AF were associated with more severe diastolic dysfunction and worse clinical outcomes than those in sinus rhythm.

Section snippets

Patients

Patients admitted into hospital with a clinical diagnosis of HF were recruited. The diagnosis was based on symptoms (dyspnea at rest, orthopnea), signs (elevated jugular venous pressure, ankle edema, pulmonary crackles), and radiographic evidence of HF (pulmonary congestion) on the admission chest radiograph. The diagnosis of HF was adjudicated by 2 independent cardiologists. Patients with acute coronary syndrome with elevation of troponin T, ST segment elevation acute myocardial infarction,

Results

There were 238 patients hospitalized for HF recruited in this study. A total of 146 patients had HFNEF and 92 had SHF. Among those with HFNEF, 104 were in SR and 42 (28.8%) in AF. For those with SHF, 62 were in SR and 30 (32.6%) in AF. Among the hospitalized patients with AF, permanent AF was present in 14 patients with HFNEF (33.3%) and 18 with SHF (60%) (prevalence of permanent AF in HFNEF versus SHF, P < .05). All patients with normal ejection fraction or systolic heart failure were in

Discussion

The principal findings of the current study are (1) AF was associated with worse morbidity in patients hospitalized for HF irrespective of baseline EF, (2) severe diastolic dysfunction was more commonly detected in HFNEF with AF when compared with SR, and (3) both AF and severe diastolic dysfunction are independent predictors of HF hospitalization or death in HFNEF.

In general, patients with HFNEF were less likely in higher NYHA class,6, 19 had better quality of life,20 and lower hospital

Acknowledgment

We are indebted to Prof. CC Szeto from Department of Medicine and Therapeutics, Prince of Wales Hospital, in providing statistical assistance.

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