Prognostic significance of diastolic dysfunction in patients with systolic dysfunction undergoing atrial fibrillation ablation. (August 2022)

• Record Type: Journal Article
• Authors: Koike, Toshiharu; Ejima, Koichiro; Kataoka, Shohei; Yazaki, Kyoichiro; Higuchi, Satoshi; Kanai, Miwa; Yagishita, Daigo; Shoda, Morio; Hagiwara, Nobuhisa
• Is Part Of: IJC heart & vasculature. Volume 41(2022)
• Publication Date: 2022-08
• Subjects: Atrial fibrillation -- Catheter ablation -- Diastolic dysfunction -- Heart failure; AAD antiarrhythmic drug -- AF atrial fibrillation -- AFMR atrial functional MR -- ATA atrial tachyarrhythmia -- AUC area under the curve -- CRT cardiac resynchronization therapy -- DT deceleration time -- E early diastolic left ventricular filling velocity -- e′ early septal diastolic mitral annular velocity -- HF heart failure -- HFH HF hospitalization -- HFrEF HF with reduced ejection fraction -- IQR interquartile ranges -- LA left atrial -- LAVI LA volume index -- LV left ventricular -- LVAD LV assist device -- LVDD left ventricular diastolic dysfunction -- LVEF LV ejection fraction -- LVSD left ventricular systolic dysfunction -- MR mitral regurgitation -- NYHA New York Heart Association -- PAF paroxysmal AF -- PMI pacemaker implantation -- rEF reduced ejection fraction -- ROC receiver operating characteristic -- SD standard deviations -- SHD structural heart disease -- TRV tricuspid valve regurgitation velocity -- VFMR ventricular functional MR; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2022.101079
• Languages: English
• ISSNs: 2352-9067

Abstract

Graphical abstract: Abstract: 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.