Background: The atrial fibrillation (AF) is a common finding and increases risk of mortality in patients (pts) with heart failure (HF). However, there have not been enough studies about prognostic factors in HF pts accompanied by AF. The purpose of this study was to investigate prognostic echocardiographic parameters in pts of acute heart failure (AHF) presented with AF.
Methods and Results: We analyzed baseline echocardiographic parameters in 83 hospitalized AHF pts who presented with AF (43 males, 67.5 ± 11.3 years old) excluding severe valvular heart diseases. Cardiovascular (CV) events were defined as cardiovascular (CV) mortality and/or heart failure rehospitalization during 1 year (median 360 days, IQR 54-360 days). In our study, median N-terminal pro-brain natriuretic peptide (NT-proBNP) was 5106 (1915.5 – 9744.5) pg/ml and mean estimated glomerular filtration rate (eGFR) was 57.5 ± 30.3 mL/min/1.73m2. Mean left ventricular ejection fraction (LVEF), left ventricular volume index (LAVI), deceleration time (DT) of the E-wave velocity, peak velocity of early diastolic filling (E), early diastolic mitral annular velocity (E’) and E/E’ were 34.9 ± 15.5 %, 68.1 ± 39.8 ml/m2, 138.2 ± 34.8 msec, 0.93 ± 0.31 cm/s, 4.56 ± 1.39 cm/s and 22.3 ± 10.3, respectively. In Kaplan-Meier analysis, higher LAVI (≥63.6 ml/m2) group showed higher CV events than lower LAVI (<63.6 ml/m2) group with statistically significance (event free survival rate ; 30.8% vs 61.5%, p=0.004). Only LAVI was an independent prognostic predictor among other echocardiographic parameters. The optimal cutoff value of LAVI for CV events prediction was 63.6 ml/m2 (AUC 0.679, sensitivity 64.3%, specificity 66.7%, p=0.007). A higher LAVI was an independent prognostic factor after adjusting age, sex, LVEF, eGFR and log NT-proBNP level (hazard ratio : 2.648, 95% CI 1.313-5.341, p=0.007) in Cox proportional hazard analysis.
Conclusion: We found that LAVI was a prognostic factor for 1-year CV mortality and/or re-hospitalization in AHF pts presented with AF and its prognostic power was independent of NT-proBNP level and other cardiovascular risk factors in these pts.
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