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

doi:10.1016/j.cardfail.2017.11.005

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

Cardiovascular Centre (CVC)

Research output: Contribution to journal › Article › Academic › peer-review

26 Citations (Scopus)

363 Downloads (Pure)

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 language	English
Pages (from-to)	177-185
Number of pages	9
Journal	JOURNAL OF CARDIAC FAILURE
Volume	24
Issue number	3
Early online date	29-Nov-2017
DOIs	https://doi.org/10.1016/j.cardfail.2017.11.005
Publication status	Published - Mar-2018

Keywords

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

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Right Heart Dysfunction in Heart Failure With PreservedFinal publisher's version, 1.39 MBLicence: CC BY-NC-ND

Cite this

Gorter, T. M., van Melle, J. P., Rienstra, M., Borlaug, B. A., Hummel, Y. M., Van Gelder, I. C., Hoendermis, E. S., Voors, A. A., Van Veldhuisen, D. J., & Lam, C. S. P. (2018). Right Heart Dysfunction in Heart Failure with Preserved Ejection Fraction: the Impact of Atrial Fibrillation. JOURNAL OF CARDIAC FAILURE, 24(3), 177-185. https://doi.org/10.1016/j.cardfail.2017.11.005

Gorter, Thomas M ; van Melle, Joost P ; Rienstra, Michiel ; Borlaug, Barry A ; Hummel, Yoran M ; Van Gelder, Isabelle C ; Hoendermis, Elke S ; Voors, Adriaan A ; Van Veldhuisen, Dirk J ; Lam, Carolyn S P. / Right Heart Dysfunction in Heart Failure with Preserved Ejection Fraction : the Impact of Atrial Fibrillation. In: JOURNAL OF CARDIAC FAILURE. 2018 ; Vol. 24, No. 3. pp. 177-185.

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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.",

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Right Heart Dysfunction in Heart Failure with Preserved Ejection Fraction : the Impact of Atrial Fibrillation. / Gorter, Thomas M; van Melle, Joost P ; Rienstra, Michiel; Borlaug, Barry A; Hummel, Yoran M; Van Gelder, Isabelle C; Hoendermis, Elke S; Voors, Adriaan A ; Van Veldhuisen, Dirk J ; Lam, Carolyn S P.

In: JOURNAL OF CARDIAC FAILURE, Vol. 24, No. 3, 03.2018, p. 177-185.

Research output: Contribution to journal › Article › Academic › peer-review

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T1 - Right Heart Dysfunction in Heart Failure with Preserved Ejection Fraction

T2 - the Impact of Atrial Fibrillation

AU - Gorter, Thomas M

AU - van Melle, Joost P

AU - Rienstra, Michiel

AU - Borlaug, Barry A

AU - Hummel, Yoran M

AU - Van Gelder, Isabelle C

AU - Hoendermis, Elke S

AU - Voors, Adriaan A

AU - Van Veldhuisen, Dirk J

AU - Lam, Carolyn S P

PY - 2018/3

Y1 - 2018/3

N2 - 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.

AB - 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.

KW - Journal Article

KW - EVENTS

KW - PRESSURES

KW - RIGHT-VENTRICULAR FUNCTION

KW - PULMONARY-HYPERTENSION

KW - INVASIVE HEMODYNAMICS

KW - REGRESSION-ANALYSIS

KW - EXERCISE CAPACITY

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DO - 10.1016/j.cardfail.2017.11.005

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JO - JOURNAL OF CARDIAC FAILURE

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