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Heart Failure in Atrial Fibrillation - An Update on Clinical and Echocardiographic Implications
Naoki Taniguchi1, Yoko Miyasaka1, Yoshinobu Suwa1
1Division of Cardiology, Department of Medicine II, Kansai Medical University.
Insights
Atrial fibrillation (AF) increases the risk of heart failure (HF). Understanding the link between AF and HF, including risk factors and subtypes like HFrEF and HFpEF, is crucial for patient outcomes.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Atrial fibrillation (AF) is the most prevalent adult arrhythmia, often leading to stroke, heart failure (HF), and mortality.
- Heart failure (HF) is a frequent complication of AF and a primary cause of death in these patients.
Purpose of the Study:
- To explore the epidemiological, pathophysiological, and prognostic links between AF and HF.
- To review clinical and echocardiographic predictors for identifying HF risk in patients with AF.
Main Methods:
- Literature review focusing on the association between AF and HF.
- Analysis of studies investigating HF subtypes (HFrEF vs. HFpEF) in AF patients.
- Examination of prognostic impacts and predictive factors.
Main Results:
- Left atrial and ventricular fibrosis are implicated as key links between AF and HF.
- Mortality risk is slightly higher in concurrent AF and HF with reduced ejection fraction (HFrEF) compared to HF with preserved ejection fraction (HFpEF).
- Left atrial size and atrial/ventricular function predict HF in AF, adding value beyond traditional risk factors.
Conclusions:
- Identifying the AF-HF association is vital for risk stratification.
- While mortality differs between HFrEF and HFpEF in AF, the overall prognostic impact of HF in AF is similar across subtypes.
- Echocardiographic assessments offer valuable predictive insights for HF in AF patients.
Abstract:
Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and has unfavorable consequences such as stroke, heart failure (HF), and death. HF is the most common adverse event following AF and the leading cause of death. Therefore, identifying the association between AF and HF is important to establish risk stratification for HF in AF. Recent studies suggested that left atrial and ventricular fibrosis is an important link between AF and HF, and the prognostic impact may differ with respect to HF subtype, stratified with left ventricular ejection fraction (EF). Mortality risk in patients with concurrent AF and HF with reduced EF (HFrEF) appears slightly higher compared with those with concurrent AF and HF with preserved EF (HFpEF). On the other hand, the prognostic impact of HF in AF is similar between HFrEF and HFpEF. Further, left atrial size, as well as left atrial and left ventricular functional assessment, are reported to be useful for the prediction of HF in AF, incremental to the conventional risk factors. In this review, we focus on the epidemiological, pathophysiological, and prognostic associations between AF and HF, and review the clinical and echocardiographic predictors for HF in AF.
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