Prognostic Impact of Echocardiographic Congestion Grade in HFpEF With and Without Atrial Fibrillation.
JACC Asia
; 2(1): 73-84, 2022 Feb.
Article
en En
| MEDLINE
| ID: mdl-36340256
ABSTRACT
Background:
Atrial fibrillation (AF) is common in heart failure with preserved ejection fraction (HFpEF).Objectives:
This study aimed to investigate the prognostic value of echocardiographic markers of congestion that can be applied to both AF and patients without AF with HFpEF.Methods:
We conducted a multicenter study of 505 patients with HFpEF admitted to hospitals for acute decompensated heart failure. The ratio of early diastolic transmitral flow velocity to mitral annulus velocity (E/e'), the tricuspid regurgitation peak velocity, and the collapsibility of the inferior vena cava were obtained at discharge. Congestion was determined by echocardiography if any one of E/e' ≥14 (E/e' ≥11 for AF), tricuspid regurgitation peak velocity ≥2.8 m/s, or inferior vena cava collapsibility <50% was positive. We classified patients into grade A, grade B, and grade C according to the number of positive congestion indices. The primary endpoint was the composite of cardiovascular death and heart failure hospitalization.Results:
During the follow-up period (median 373 days), 162 (32%) patients experienced the primary endpoint. Grade C patients had a higher risk for the primary endpoint than grade A (HR 2.98; 95% CI 1.97-4.52) and grade B patients (HR 1.92; 95% CI 1.29-2.86) (log-rank P < 0.0001). Echocardiographic congestion grade improved the predictive value when added to the age, sex, New York Heart Association functional class, and N-terminal pro-B-type natriuretic peptide, not only in sinus rhythm (Uno C-statistic 0.670 vs 0.655) but in AF (Uno C-statistic 0.667 vs 0.639).Conclusions:
Echocardiographic congestion grade has prognostic value in patients with HFpEF with and without AF.
AF, atrial fibrillation; ASE, American Society of Echocardiography; E/e', ratio of early diastolic transmitral flow velocity to mitral annulus velocity; EACVI, European Association of Cardiovascular Imaging; HFpEF, heart failure with preserved ejection fraction; IVC, inferior vena cava; IVCC, inferior vena cava collapsibility; NT-proBNP, N-terminal proB-type natriuretic peptide; NYHA, New York Heart Association; TRV, tricuspid regurgitation peak velocity; congestion; echocardiography; heart failure with preserved ejection fraction; prognosis
Texto completo:
1
Banco de datos:
MEDLINE
Tipo de estudio:
Clinical_trials
/
Prognostic_studies
Idioma:
En
Revista:
JACC Asia
Año:
2022
Tipo del documento:
Article
País de afiliación:
Japón