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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Prognostic significance of diastolic dysfunction in patients with systolic dysfunction undergoing atrial fibrillation
Toshiharu Koike1, Koichiro Ejima1,2, Shohei Kataoka1
1Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Insights
Pre-ablation diastolic dysfunction in patients with systolic dysfunction undergoing atrial fibrillation ablation predicts poor outcomes. Early identification and intensive management of left ventricular diastolic dysfunction are crucial for improved prognosis.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- The prognostic impact of pre-ablation left ventricular diastolic dysfunction (LVDD) in patients with left ventricular systolic dysfunction (LVSD) undergoing atrial fibrillation (AF) ablation is not well-defined.
- LVSD and AF commonly coexist, complicating patient management and outcomes.
Purpose of the Study:
- To investigate the association between pre-ablation LVDD parameters and clinical outcomes in patients with LVSD following AF ablation.
- To identify specific LVDD echocardiographic markers that predict adverse events after AF ablation.
Main Methods:
- A cohort of 173 patients with LVSD (ejection fraction <50%) undergoing AF ablation was analyzed.
- The primary outcome included all-cause mortality, heart failure hospitalization, and worsening heart failure symptoms.
- Receiver operating characteristic (ROC) curve analysis and multivariate analysis were used to assess LVDD parameters, including early septal diastolic mitral annular velocity (e'), septal E/e', and peak tricuspid valve regurgitation velocity (TRV).
Main Results:
- The primary outcome occurred in 16% of patients over a median follow-up of 3.5 years.
- Early septal diastolic mitral annular velocity (e') demonstrated the highest predictive value among LVDD parameters (AUC=0.70).
- Optimal cut-off values for adverse outcomes were identified as e' ≤5.0 cm/s, septal E/e' ≥13.2, and peak TRV ≥2.5 m/s. Patients with New York Heart Association functional class ≥III had a significantly higher risk.
Conclusions:
- Pre-ablation LVDD, particularly when indicated by specific echocardiographic values (e' ≤5.0 cm/s, septal E/e' ≥13.2, peak TRV ≥2.5 m/s), is an independent predictor of poor prognosis after AF ablation in patients with LVSD.
- Severe heart failure symptoms (NYHA class ≥III) also portend a worse outcome.
- Patients with LVDD or severe HF symptoms require intensified management strategies post-ablation to improve outcomes.
Background:
The relationship between pre-ablation left ventricular diastolic dysfunction (LVDD) and prognosis in patients with left ventricular systolic dysfunction (LVSD) undergoing atrial fibrillation (AF) ablation remains unclear.
Methods:
The prognosis of 173 patients with impaired left ventricular ejection fraction (<50%) who underwent AF ablation was examined. The primary outcome was a composite of all-cause mortality, heart failure (HF) hospitalization, and worsening HF symptoms requiring unplanned outpatient intensification of decongestive therapy.
Results:
During the follow-up period (median, 3.5 years), the primary outcome after AF ablation occurred in 28 patients (16%). The receiver operating characteristic curve analysis showed that early septal diastolic mitral annular velocity (e') had a larger area under the curve (0.70) than other LVDD parameters, and optimal cut-off values of LVDD, represented by e', septal E (early diastolic left ventricular filling velocity)/e', and peak tricuspid valve regurgitation velocity (TRV), were 5.0 cm/s, 13.2, and 2.5 m/s, respectively. Multivariate analysis revealed that e' ≤5.0 cm/s (standard hazard ratio [HR], 3.87; 95% confidence interval [CI], 1.73-8.69; p = 0.001), septal E/e' ≥13.2 (HR, 3.62; 95% CI, 1.60-8.21; p = 0.002), and peak TRV ≥ 2.5 m/s (HR, 2.42; 95% CI, 1.13-5.16; p = 0.02) independently predicted the outcome. Patients with New York Heart Association functional status ≥ III had a 3.3-4.5-fold higher risk of the outcome.
Conclusions:
LVDD or severe HF symptoms predict poor outcomes in patients with LVSD undergoing AF ablation. Therefore, patients with LVDD or severe HF symptoms should receive more intensive treatment even after AF ablation.
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