Relation Between Postoperative Mortality and Atrial Fibrillation Before Surgical Revascularization - 3-Year Follow-Up
Maciej BanachAleksander GochMałgorzata MisztalJacek RyszJanusz ZasłonkaJan Henryk GochRyszard Jaszewski
37
Citation
0
Reference
10
Related Paper
Citation Trend
Abstract:
Preoperative atrial fibrillation is one of the predictors of increased morbidity and mortality in patients undergoing surgical revascularization, and consequently, prolongs the duration of stay in the ICU and of overall hospitalization.The study included 3000 patients subjected to primary isolated coronary artery bypass grafting from 2000 to 2004. Of the 3000 patients, 5.8 % (n = 174) had electrocardiographically documented, preoperative atrial fibrillation. To evaluate the relationship between preoperative AF and postoperative outcome, all patients were observed for about three years.Patients with preoperative atrial fibrillation were older (P < 0.05), had a lower ejection fraction (P < 0.001), a higher incidence of heart failure (P < 0.001), hypertension (P < 0.001), and more coexistent morbidities including diabetes (P < 0.05), obturative pulmonary disease (P < 0.0001) and mild renal failure (P < 0.001). Statistical analysis showed that survival rates at 6 and 30 days, 6 and 12 months, and 3 years following surgical revascularization of patients with vs. those without preoperative atrial fibrillation were: 96.4% vs. 98.1%, and 94.5% vs. 97.3% (P = ns), 86.2% vs. 93.0% (P < 0.03), and 74.7% vs. 91.0% (P < 0.02), and 70.7% vs. 90.6% (P < 0.01). After 3 years' observation there was a survival difference of 19.9%. We showed that preoperative atrial fibrillation triple increased the risk of postoperative AF and was an independent risk factor for in-hospital death (P < 0.001).Preoperative atrial fibrillation is a predictor of postoperative complications, including death, and of a significant reduction in patients' long-term survival. Patients with preoperative atrial fibrillation should be considered as high-risk patients with potential postoperative complications and should be well protected with antiarrhythmic and anticoagulant therapy.Clinical feature of heart failure with improved ejection fraction (HFimpEF) remains to be fully elucidated. The present study investigated the association of clinical and echocardiographic parameters with the subsequent improvement of left ventricular ejection fraction (LVEF) in heart failure with reduced ejection fraction (HFrEF).From outpatients with a history of hospitalized for heart failure, 128 subjects diagnosed as HFrEF (LVEF <40%) on heart failure hospitalization were enrolled and longitudinally surveyed. During follow-up periods more than 1 year, 58 and 42 patients were identified as HFimpEF (improved LVEF to ≥40% and its increase of ≥10 points) and persistent HFrEF, respectively.There was no difference in age or sex between the two groups with HFimpEF and persistent HFrEF. The rate of ischemic heart disease was lower and that of tachyarrhythmia was higher in the HFimpEF group than in the persistent HFrEF group. At baseline (i.e., on heart failure hospitalization), LVEF did not differ between the two groups, but left ventricular systolic and diastolic diameters were already smaller and the ratio of early diastolic transmitral velocity to early diastolic tissue velocity (E/e') was lower in the HFimpEF group. A multiple logistic regression analysis revealed that lower baseline E/e' was a significant determinant of HFimpEF, independently of confounding factors such as ischemic heart disease, tachyarrhythmia, and baseline left ventricular dimension.Our findings indicate that the lower ratio of E/e' in the acute phase of heart failure onset is an independent predictor of the subsequent improvement of LVEF in HFrEF patients.
Diastolic heart failure
Cite
Citations (5)
Heart failure is a major public health problem. Patients with heart failure often experience dyspnoea, fatigue and/or have peripheral oedema. The prognosis of heart failure remains poor, with a severely impaired quality of life, frequent hospitalizations and a five-year mortality rate around 50%. The two most prevalent forms of heart failure are heart failure with a reduced ejection fraction and heart failure with a preserved ejection fraction. Several medical treatments have greatly improved clinical outcomes in heart failure with a reduced ejection fraction, but these therapies have unfortunately not been proven effective in patients with heart failure with a preserved ejection fraction. Atrial fibrillation is the most common arrhythmia in heart failure, with a prevalence between 25-65% depending on the type and severity of heart failure. Important differences have been observed between men and women with heart failure and atrial fibrillation, yet poorly understood. The aim of this thesis was to examine the complex pathophysiological interplay between men and women with atrial fibrillation and heart failure with reduced versus preserved ejection fraction, which will ultimately lead to better treatments.The thesis describes that the optimal doses of heart failure medication for women appeared lower than in men (around 50% of the doses that are currently recommended), which could have important clinical implications. Another study revealed profound differences in biomarkers profiles in patients with atrial fibrillation and heart failure with a reduced ejection fraction as compared to those with a preserved ejection fraction.
Cite
Citations (0)
Hypertensive heart disease
Cite
Citations (1)
Background There have been no reports that show significant direct relationship between echocardiographic parameters and B‐type natriuretic peptide ( BNP ) level. This could be due to the heterogeneous pathophysiology of heart failure and a lack of appropriate echocardiographic parameters. We sought to determine the best echocardiographic parameter that described elevated BNP level in patients with heart failure with and without systolic dysfunction. Methods and Results We studied 111 consecutive heart failure patients. They were divided into patients with heart failure and preserved ejection fraction ( HFPEF , n = 61) and that with heart failure and reduced ejection fraction ( HFREF , n = 50). Conventional and new echocardiographic parameters including myocardial strains were measured. BNP did not reflect any single echocardiographic parameter in patients with heart failure in total. The ratio of early diastolic transmitral flow velocity and mitral annular velocity had strong positive correlation with BNP level in the HFPEF group but not in the HFREF group. In the group of HFREF , global longitudinal and circumferential strains were positively correlated. Multivariate analysis revealed that predicted factors for BNP value in HFPEF and in HFREF were different. Conclusion High BNP level may indicate high filling pressure when ejection fraction is preserved and may indicate myocardial dysfunction when it is reduced.
Cite
Citations (6)
Objectives
To investigate the clinical characteristics of elderly inpatients with heart failure (HF) with preserved ejection fractionand and atrial fibrillation (AF).
Methods
The elderly inpatients (age≥60 years) with HF and AF hospitalized in Fujian Medical University Union Hospital from January 1, 2014 to January 1, 2017 were enrolled and divided into two subgroups based on left ventricular ejection fraction (LVEF), heart failure with preserved ejection fraction and AF (HFpEF-AF, LVEF≥40%)and heart failure with reduced ejection fraction and AF (HFrEF-AF, LVEF<40%). Clinical characteristics between these two groups were compared.
Results
A total of 696 elderly inpatients with HF and AF were enrolled, of which 545 cases were HFpEF-AF (78.3%) and other 151 were HFrEF-AF. Compared with HFrEF-AF, patients with HFpEF-AF were older with higher body mass index, more women and higher proportion of hypertension (all P 0.05). The in-hospital mortality of HFpEF-AF patients was higher than that of HFrEF-AF patients without significant difference (6.4% vs. 4.0%, P=0.258).
Conclusions
The majority of elderly inpatients with HF and AF was HFpEF-AF. Compared with HFrEF-AF patients, HFpEF-AF patients were older, fatter, with more women and higher proportion of hypertension. The risk of stroke and in-hospitality mortality was higher in patients with HFpEF-AF compared to HFrEF-AF despite without significant difference.
Key words:
Heart failure; Left ventricular ejection fraction; Atrial fibrillation; Elderly; Stroke
Stroke
Cite
Citations (0)
Background Many patients with heart failure (HF) experience changes in left ventricular ejection fraction (LVEF) during follow-up. We sought to evaluate the predictors and outcomes of different HF phenotypes according to longitudinal changes in EF. Methods and Results A total of 2104 patients with acute HF underwent echocardiography at baseline and follow-up. Global longitudinal strain was measured at index admission. HF phenotypes were defined as persistent HF with reduced EF (persistent HFrEF, LVEF ≤40% at baseline and follow-up), heart failure with improved ejection fraction (LVEF≤40% at baseline and improved to >40% at follow-up), heart failure with declined ejection fraction (LVEF>40% at baseline and declined to ≤40% at follow up), and persistent HF with preserved EF (persistent HFpEF, LVEF>40% at baseline and follow-up). Overall, 1130 patients had HFrEF at baseline; during follow-up, 54.2% and 46.8% had persistent HFrEF and heart failure with improved ejection fraction, respectively. Among 975 patients with HFpEF at baseline, 89.5% and 10.5% had persistent HFpEF and heart failure with declined ejection fraction at follow-up, respectively. The 5-year all-cause mortality rates were 43.1%, 33.1%, 24%, and 17% for heart failure with declined ejection fraction, persistent HFrEF, persistent HFpEF, and heart failure with improved ejection fraction, respectively (global log-rank P<0.001). In multivariable analyses, each 1% increase in global longitudinal strain (greater contractility) was associated with 10% increased odds for heart failure with improved ejection fraction among patients with HFrEF at baseline and 7% reduced odds for heart failure with declined ejection fraction among patients with HFpEF at baseline. Conclusions LVEF changed during follow-up. Each HF phenotype according to longitudinal LVEF changes has a distinct prognosis. Global longitudinal strain can be used to predict the HF phenotype. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03513653.
Contractility
Cite
Citations (40)
Cite
Citations (81)
Cite
Citations (19)
Cite
Citations (53)
Objective To investigate the level differences of plasma brain natriuretic peptide(BNP) in patients with chronic stable and decompensation heart failure and their relationship among BNP,left ventricular ejection fraction(LVEF) and left ventricular end-diastolic diameter(LVEDD).Methods Ninety-six patients with heart failure were examined by UCG after admission,and they were divided into three groups according to NYHA's heart function class criterion:NYHA class Ⅱ group 40 cases,including chronic stable heart failure 14 cases;decompensation heart failure 26 cases;NYHA class Ⅲ group 40 cases;including chronic stable heart failure 16 cases;decompensation heart failure 24 cases;NYHA class Ⅳ group 16 cases,including chronic stable heart failure 4 cases;heart failure 12 cases.The concentration of BNP was measured by Achitect I2000SR full-automatic chemiluminesent immunoassay(CLIA).Results The concentration of BNP between NYHA class Ⅱ,Ⅲ,Ⅳ groups(include chronic stable and decompensation groups) had significant differences(P0.05);LVEED and LVEF between NYHA class Ⅱ,Ⅲ,Ⅳ groups in chronic stable groups had significant differences(P0.05);but had no significant differences between decompensation groups(P0.05).Conclusion The level of BNP and NYHA classes had a positive relationship,had positive relationship between LVEED and LVEF and NYHA classes in stable heart failure groups,had no relationship between LVEED and LVEF and NYHA classes in decompensation heart failure groups.
Decompensation
Brain natriuretic peptide
Cite
Citations (0)