Prevalence and Incidence of Atrial Fibrillation in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: (Additive) Value of Implantable Loop Recorders
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Study Population
2.3. Definition of Atrial Fibrillation
2.4. Study Procedures
2.4.1. Implantable Loop Recorder
2.4.2. Rhythm Monitoring
2.5. Statistical Analysis
3. Results
3.1. Clinical Associations with Prevalent Atrial Fibrillation
3.2. Incident Atrial Fibrillation and Diagnostic Yield for Atrial Fibrillation Detection
4. Discussion
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total n = 113 | No AF History n = 43 | AF History n = 70 | p-Value | |
---|---|---|---|---|
Age | 73 ± 8 | 70 ± 8 | 74 ± 8 | 0.01 |
Sex, female | 58 (51%) | 18 (42%) | 40 (57%) | 0.1 |
Body mass index, kg/m2 | 29.8 ± 5.7 | 28.7 ± 5.3 | 30.4 ± 5.9 | 0.1 |
Comorbidities | ||||
Hypertension | 88 (78%) | 31 (72%) | 57 (81%) | 0.2 |
Coronary artery disease | 39 (35%) | 19 (44%) | 20 (29%) | 0.09 |
Diabetes mellitus | 45 (40%) | 13 (30%) | 32 (46%) | 0.1 |
Renal dysfunction | 54 (48%) | 19 (44%) | 35 (50%) | 0.5 |
Obesity | 45 (40%) | 16 (43%) | 29 (45%) | 0.8 |
Chronic obstructive pulmonary disease | 21 (19%) | 9 (21%) | 12 (17%) | 0.6 |
CHA2DS2-VASc | 5 [4–6] | 4 [3–6] | 5 [4–6] | 0.3 |
Echocardiography (n = 113) | ||||
LV ejection fraction, % | 54 ± 6 | 53 ± 7 | 54 ± 6 | 0.4 |
LV ejection fraction ≥50% | 85 (75%) | 28 (65%) | 57 (81%) | 0.051 |
LV mass index, g/m2 | 102 ± 37 | 116 ± 48 | 94 ± 26 | 0.01 |
E/e′ | 13.1 ± 5.0 | 12.3 ± 4.6 | 13.9 ± 5.2 | 0.2 |
Mean e′ septal/lateral wall, cm/s | 7.5 ± 2.1 | 6.6 ± 1.7 | 8.3 ± 2.1 | <0.001 |
LA volume index, mL/m2 | 47 ± 16 | 40 ± 16 | 50 ± 15 | 0.002 |
TAPSE. mm | 20.4 ± 4.8 | 21.5 ± 5.6 | 19.7 ± 4.1 | 0.06 |
RV s′, cm/s | 11.5 ± 2.7 | 12.3 ± 2.7 | 10.8 ± 2.5 | 0.01 |
TR peak gradient, mmHg | 34 ± 11 | 34 ± 10 | 34 ± 11 | 0.9 |
Laboratory test (n = 113) | ||||
Creatinin, µmol/L | 122 ± 54 | 125 ± 59 | 120 ± 51 | 0.6 |
eGFR, mL/min/1.73 m2 | 52 ± 21 | 53 ± 21 | 52 ± 22 | 0.7 |
NT-proBNP, ng/L | 1367 [729–2430] | 800 [513–1787] | 1665 [1065–2553] | 0.003 |
24-Hour Holter (n = 112) | ||||
Mean heart rate | 72 ± 13 | 67 ± 8 | 74 ± 15 | 0.001 |
Cardiac MRI (n = 105) | ||||
Left ventricle | ||||
LV ejection fraction, % | 53 ± 8 | 53 ± 9 | 52 ± 8 | 0.8 |
LV end-diastolic volume index, mL/m2 | 89 ± 25 | 98 ± 27 | 84 ± 22 | 0.004 |
LV end-systolic volume index, mL/m2 | 43 ± 17 | 48 ± 20 | 41 ± 15 | 0.06 |
LV mass index, g/m2 | 57 ± 23 | 66 ± 28 | 52 ± 18 | 0.005 |
LV global longitudinal strain, % | −16.8 ± 5.0 | −17.4 ± 4.6 | −16.4 ± 5.3 | 0.3 |
LV circumferential strain, % | −22.0 ± 6.1 | −23.4 ± 6.5 | −21.1 ± 5.8 | 0.07 |
Right ventricle | ||||
RV ejection fraction, % | 53 ± 10 | 58 ± 11 | 49 ± 8 | <0.001 |
RV end-diastolic volume index, mL/m2 | 81 ± 20 | 78 ± 16 | 83 ± 22 | 0.2 |
RV end-systolic volume index, mL/m2 | 39 ± 15 | 33 ± 12 | 43 ± 15 | 0.001 |
RV global longitudinal strain (%) | −19.4 ± 6.2 | −21.3 ± 6.8 | −18.2 ± 5.5 | 0.01 |
Stroke volume/end-systolic volume | 1.2 ± 0.6 | 1.5 ± 0.7 | 1.0 ± 0.3 | <0.001 |
Atria | ||||
LA volume index, mL/m2 | 62 ± 22 | 54 ± 20 | 68 ± 21 | 0.002 |
LA emptying fraction, % | 29 ± 16 | 38 ± 15 | 23 ± 14 | <0.001 |
LA reservoir strain, % | 13.6 ± 9.2 | 18.1 ± 10.5 | 10.8 ± 6.8 | <0.001 |
LA conduit strain, % (n = 61) | 9.9 ± 5.4 | 10.0 ± 6.1 | 9.9 ± 3.7 | 0.9 |
LA booster strain, % (n = 61) | 8.0 ± 5.5 | 8.3 ± 6.2 | 7.6 ± 4.1 | 0.7 |
RA volume index, mL/m2 | 46 ± 22 | 38 ± 18 | 51 ± 24 | 0.002 |
RA emptying fraction, % | 28.4 ± 15.9 | 39 ± 13 | 21 ± 13 | <0.001 |
RA reservoir strain, % | 18.5 ± 13.3 | 24.9 ± 13.2 | 14.4 ± 11.7 | <0.001 |
RA conduit strain, % (n = 61) | 10.3 ± 6.5 | 10.7 ± 6.6 | 9.6 ± 6.3 | 0.5 |
RA booster strain, % (n = 61) | 14.4 ± 9.4 | 14.3 ± 9.6 | 14.6 ± 9.4 | 0.9 |
Medication | ||||
Beta blockers | 98 (87%) | 34 (79%) | 64 (91%) | 0.06 |
ACEi/ARB | 72 (64%) | 31 (72%) | 41 (59%) | 0.1 |
MRA | 44 (39%) | 18 (42%) | 26 (37%) | 0.6 |
Loop diuretics | 101 (89%) | 38 (88%) | 63 (90%) | 0.8 |
Class 1 AAD | 0 | 0 | 0 | |
Class 3 AAD | 5 (4%) | 0 | 5 (7%) | 0.07 |
Non-dihydropyridine CCB | 6 (5%) | 3 (7%) | 3 (4%) | 0.5 |
Digoxin | 23 (20%) | 0 | 23 (33%) | <0.001 |
DOAC/VKA | 67 (59%) | 0 | 67 (96%) | <0.001 |
Univariable Cox Regression Analysis | ||
---|---|---|
Hazard Ratio [95% CI] | p-Value | |
Age, per year | 1.45 [0.90–2.34] | 0.1 |
Male sex | 0.95 [0.38–2.38] | 0.9 |
Body mass index, per SD increase | 1.35 [0.82–2.22] | 0.2 |
Heart rate, per SD increase | 0.85 [0.43–1.71] | 0.7 |
Systolic blood pressure, per SD increase | 1.26 [0.89–1.79] | 0.2 |
Diastolic blood pressure, per SD increase | 1.04 [0.63–1.71] | 0.9 |
Comorbidities | ||
Hypertension | 1.05 [0.37–2.94] | 0.9 |
Diabetes mellitus | 0.49 [0.16–1.48] | 0.2 |
Coronary artery disease | 1.02 [0.41–2.52] | 0.97 |
CHA2DS2-VASc | 1.09 [0.82–1.46] | 0.6 |
Echocardiography | ||
LV ejection fraction, per SD increase | 0.93 [0.62–1.41] | 0.7 |
LV mass index, per SD increase | 1.08 [0.79–1.50] | 0.6 |
E/e′, per SD increase | 0.85 [0.49–1.50] | 0.6 |
Mean e′ septal/lateral wall, per SD increase | 0.84 [0.45–1.59] | 0.6 |
LA volume index, per SD increase | 2.10 [1.30–3.42] | 0.003 |
TAPSE, per SD increase | 1.21 [0.73–1.72] | 0.6 |
RV s′, per SD increase | 0.95 [0.59–1.52] | 0.8 |
>mild mitral regurgitation | 3.46 [0.97–12.33] | 0.056 |
Laboratory test | ||
NT-proBNP, per Ln increase | 1.26 [0.80–1.98] | 0.3 |
eGFR, per Ln increase | 0.98 [0.35–2.77] | 0.98 |
Medication | ||
Beta blockers | 2.27 [0.52–9.93] | 0.3 |
ACEi/ARB | 1.23 [0.45–3.46] | 0.7 |
MRA | 0.67 [0.25–1.80] | 0.4 |
Loop diuretics | 1.07 [0.25–4.70] | 0.9 |
Univariable Cox Regression Analysis | ||
---|---|---|
Hazard Ratio [95% CI] | p-Value | |
LV end-diastolic volume index, per SD increase | 1.10 [0.70–1.72] | 0.7 |
LV end-systolic volume index, per SD increase | 1.29 [0.85–1.94] | 0.2 |
LV ejection fraction, per SD increase | 0.70 [0.45–1.10] | 0.1 |
LV mass index, per SD increase | 0.69 [0.63–1.47] | 0.8 |
RV end-diastolic volume index, per SD increase | 1.12 [0.62–2.03] | 0.7 |
RV end-systolic volume index, per SD increase | 1.26 [0.72–2.21] | 0.4 |
RV ejection fraction, per SD increase | 0.86 [0.56–1.31] | 0.4 |
RV mass index, per SD increase | 0.82 [0.52–1.30] | 0.4 |
LA end-systolic volume index, per SD increase | 1.94 [1.12–3.34] | 0.017 |
LA end-diastolic volume index, per SD increase | 2.14 [1.24–3.69] | 0.006 |
LA emptying fraction, per SD increase | 0.75 [0.43–1.30] | 0.3 |
LA reservoir strain, per SD increase | 0.86 [0.54–1.35] | 0.5 |
LA passive strain, per SD increase | 0.91 [0.61–1.36] | 0.6 |
LA active strain, per SD increase | 0.89 [0.54–1.45] | 0.6 |
RA volume index, per SD increase | 1.02 [0.54–1.93] | 0.9 |
RA emptying fraction, per SD increase | 0.71 [0.39–1.30] | 0.3 |
RA reservoir strain, per SD increase | 0.83 [0.50–1.36] | 0.4 |
RA passive strain, per SD increase | 0.95 [0.58–1.55] | 0.8 |
RA active strain, per SD increase | 0.60 [0.44–1.31] | 0.3 |
LV global longitudinal strain, per SD increase | 0.90 [0.55–1.46] | 0.7 |
LV circumferential strain, per SD increase | 0.97 [0.63–1.49] | 0.9 |
RV global longitudinal strain, per SD increase | 1.12 [0.73–1.72] | 0.6 |
RV coupling, per SD increase | 0.85 [0.53–1.38] | 0.5 |
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Gorter, T.M.; van Veldhuisen, D.J.; Mulder, B.A.; Artola Arita, V.A.; van Empel, V.P.M.; Manintveld, O.C.; Tieleman, R.G.; Maass, A.H.; Vernooy, K.; van Gelder, I.C.; et al. Prevalence and Incidence of Atrial Fibrillation in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: (Additive) Value of Implantable Loop Recorders. J. Clin. Med. 2023, 12, 3682. https://doi.org/10.3390/jcm12113682
Gorter TM, van Veldhuisen DJ, Mulder BA, Artola Arita VA, van Empel VPM, Manintveld OC, Tieleman RG, Maass AH, Vernooy K, van Gelder IC, et al. Prevalence and Incidence of Atrial Fibrillation in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: (Additive) Value of Implantable Loop Recorders. Journal of Clinical Medicine. 2023; 12(11):3682. https://doi.org/10.3390/jcm12113682
Chicago/Turabian StyleGorter, Thomas M., Dirk J. van Veldhuisen, Bart A. Mulder, Vicente A. Artola Arita, Vanessa P. M. van Empel, Olivier C. Manintveld, Robert G. Tieleman, Alexander H. Maass, Kevin Vernooy, Isabelle C. van Gelder, and et al. 2023. "Prevalence and Incidence of Atrial Fibrillation in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: (Additive) Value of Implantable Loop Recorders" Journal of Clinical Medicine 12, no. 11: 3682. https://doi.org/10.3390/jcm12113682