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Published on: July 20, 2022
Inter-atrial block as a predictor of adverse outcomes in patients with HFpEF
Jerremy Weerts1,2, Sanne G J Mourmans1, Helena Lopez-Martinez2
1Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands.
Insights
Inter-atrial block (IAB) indicates electrical atrial dysfunction and predicts adverse events in heart failure with preserved ejection fraction (HFpEF). Patients without IAB show a very low risk for adverse outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Inter-atrial block (IAB) is a marker of electrical atrial dysfunction linked to increased risks of atrial fibrillation (AF) and adverse events.
- The prognostic significance of IAB in heart failure with preserved ejection fraction (HFpEF) is not well-established.
Purpose of the Study:
- To determine the prevalence of IAB in HFpEF patients.
- To investigate the association of IAB and AF with adverse events in HFpEF across ambulatory and recently hospitalized settings.
Main Methods:
- Baseline ECGs and medical history were analyzed in HFpEF patients.
- Patients were categorized into HFpEF without IAB, with IAB, or with AF.
- Adverse events included HF hospitalization, cardiac death, or sudden death over 33 months.
Main Results:
- In ambulatory HFpEF patients, rates of composite endpoints were 0% (no IAB), 11% (IAB), and 24% (AF).
- In recently hospitalized HFpEF patients, rates of composite endpoints were 32% (no IAB), 42% (IAB), and 79% (AF).
- Progressive stages of electrical atrial dysfunction (IAB and AF) were associated with significantly increased risks of adverse events.
Conclusions:
- Progressive electrical atrial dysfunction (IAB and AF) serves as a prognostic marker for adverse outcomes in HFpEF patients.
- Ambulatory HFpEF patients without IAB exhibit a very low risk of adverse outcomes.
- Further research is needed to determine if these low-risk patients benefit from less intensive management.
Aims:
Inter-atrial block (IAB), a marker of electrical atrial dysfunction, is associated with an increased risk of atrial fibrillation (AF) and adverse events in various populations. The prognostic impact of IAB in heart failure (HF) with preserved ejection fraction (HFpEF) remains unknown. The aim of this study is to determine the prevalence of IAB and the association of IAB and AF with adverse events in HFpEF across different healthcare settings.
Methods And Results:
To identify electrical atrial dysfunction, baseline ECG's and medical history were analysed in HFpEF patients in an ambulatory setting and after recent HF hospitalisation. Patients were categorised into (i) HFpEFNo IAB, (ii) HFpEFIAB, or (iii) HFpEFAF. Adverse events included HF hospitalisation, cardiac/sudden death and a composite of both. The ambulatory cohort included 372 patients [mean age 75 ± 7 years, 252 (68%) females]. The recently hospitalised cohort included 132 patients [mean age 81 ± 10 years, 80 (61%) females]. Ambulatory patients included 17 (4%) HFpEFnoIAB, 114 (31%) HFpEFIAB and 241 (65%) HFpEFAF, while recently hospitalised patients included 31 (23%), 73 (55%) and 28 (21%), respectively. After 33 months of follow-up of ambulatory patients, composite endpoints occurred in 0 (0%) HFpEFnoIAB, 12 (11%) HFpEFIAB [HR 4.1 (95% CI 0.5-522.6)] and 59 (24%) HFpEFAF patients [HR 10.1 (95% CI 1.5-1270.4), P < 0.001]. Recently hospitalised patients showed a similar trend, with composite endpoints in 10 (32%) HFpEFnoIAB, 31 (42%) HFpEFIAB (HR 1.5 [95% CI 0.7-3.1]) and 22 (79%) HFpEFAF (HR 3.8 [95% CI 1.8-8.1], P < 0.001).
Conclusions:
Progressive stages of electrical atrial dysfunction appeared to be prognostic markers of adverse outcomes in ambulatory and recently hospitalised patients with HFpEF. Ambulatory patients with HFpEF and no early stages of electrical atrial dysfunction showed to be at very low risk for adverse outcomes. Whether such patients benefit less strict management remains to be investigated.
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