P1372Prognostic impact of persistent atrial fibrillation in heart failure patients with preserved ejection fraction a prospective observational study

Abstract

Background and Objectives: Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) frequently occur together. However, data on AF subtype and its association with comorbidities, extracellular volume (ECV) by cardiac magnetic resonance imaging (CMR), hemodynamics, and relation to outcome in HFpEF are sparse. Methods and Results: From 2011 to 2015 152 consecutive HFpEF patients were enrolled in our prospective observational registry. All patients underwent echocardiography, left and right heart catheterization (RHC), and CMR including T1 mapping with the modified Look-Locker inversion recovery (MOLLI) sequence. Patients with significant coronary artery disease were excluded. 105 patients (69%) suffered from AF, 85 (56%) had persistent and 20 (13%) had paroxysmal AF. Patients with persistent AF were in worse New York Heart Association functional class (p=0.006), and more often suffered from chronic obstructive pulmonary disease (p=0.018) than patients with paroxysmal AF or sinus rhythm. They had higher levels of N-terminal pro-brain natriuretic peptide (NTproBNP) (p=<0.001), and worse renal function (p=0.041). Invasive hemodynamics showed higher right atrial pressures (p=0.014) and pulmonary capillary wedge pressures (p=0.050). Echocardiography revealed more pronounced atrial dilatation (p=<0.001) as well as a more dilated right ventricle (p=0.001) and higher systolic pulmonary artery pressures (p=0.037). By CMR left and right atria as well as the right ventricle were more dilated (p=0.001, 0.002, and 0.001, respectively) and left and right ventricular ejection fractions were lower in patients with persistent AF (p=0.002 and <0.001 respectively). Furthermore, these patients had higher levels of ECV by T1 mapping (p=0.018). After a median follow-up of 46 months (13-71) 63 patients (41%) reached the combined endpoint defined as hospitalization for HF and/or cardiovascular death. By multivariate Cox regression analysis only persistent AF (p=0.039, HR 2.013, 95% CI 1.035-3.915) and six-minute walk distance (p=0.013, HR 0.997, 95% CI 0.994-0.999) were independently associated with outcome. Conclusion: More than 50% of HFpEF patients suffer from persistent AF. Persistent but not paroxysmal AF is significantly related with markers of disease severity, extracellular volume accumulation, and worse cardiovascular outcome. (Figure Presented).