Right Heart Dysfunction in Heart Failure with Preserved Ejection Fraction: the Impact of Atrial Fibrillation

Thomas M Gorter, Joost P van Melle, Michiel Rienstra, Barry A Borlaug, Yoran M Hummel, Isabelle C Van Gelder, Elke S Hoendermis, Adriaan A Voors, Dirk J Van Veldhuisen, Carolyn S P Lam

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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: 102 patients were identified. RV function was assessed using multiple echocardiographic parameters and dysfunction was present if ≥2 parameters were below the recommended cutoff. RV function, right atrial (RA) reservoir strain and RA emptying fraction, were compared between AF and sinus rhythm. 91 patients with sufficient echocardiographic quality were included: 45 (50%) had no history of AF; 14 (15%) had prior AF while in sinus rhythm; 32 (35%) had current AF. The prevalence of RV dysfunction varied across subgroups never AF, prior AF and current AF (20%, 43% and 63%, respectively, p=0.001). AF was associated with RV dysfunction (OR 4.70 [1.82-12.1], p=0.001) - independent of pulmonary pressures. In patients in sinus rhythm with prior AF, RA emptying fraction was lower compared to patients without AF history (41 vs. 60%, p=0.002). Prior AF was also associated with reduced RA reservoir strain (OR 4.57 [1.05-19.9], p=0.04) - independent of RV end-diastolic pressure.

CONCLUSIONS: Atrial fibrillation is strongly related to reduced RV and RA function in HFpEF, independent of pulmonary pressures.

Original languageEnglish
Pages (from-to)177-185
Number of pages9
JournalJOURNAL OF CARDIAC FAILURE
Volume24
Issue number3
Early online date29-Nov-2017
DOIs
Publication statusPublished - Mar-2018

Keywords

  • Journal Article
  • EVENTS
  • PRESSURES
  • RIGHT-VENTRICULAR FUNCTION
  • PULMONARY-HYPERTENSION
  • INVASIVE HEMODYNAMICS
  • REGRESSION-ANALYSIS
  • EXERCISE CAPACITY

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