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Prevalence of Atrial Fibrillation in Systolic Heart Failure, Pulsed and Tissue Doppler Echocardiographic Abnormalities

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DOI: 10.4236/ijcm.2013.411089    2,365 Downloads   3,429 Views  

ABSTRACT

Background: Heart failure (HF) is a common clinical syndrome mostly due to the impaired ability of the Left Ventricle (LV) to eject blood with reduced cardiac output. Heart failure is called systolic (SHF) if left ventricle ejection fraction on echo-cardiogram is low (LVEF of ≤50%). Aim: To assess the echocardiographic characteristics of patients with SHF with Atrial Fibrillation (AF) and compare with those with Sinus Rhythm (SR) on 12 leads ECG. Furthermore, to evaluate the clinical and biochemical markers for the prediction of AF in SHF. Method: Over two years duration, each patient diagnosed with SHF was enrolled in the study (n = 354) based on admission code. AF or sinus rhythm on 12 leads ECG was documented on each patient. Multiple logistic regression analysis was applied to assess the risk ratio of different clinical and Doppler derived variables for the development of AF in SHF. Results: Out of the total hospital medical admissions of 14,674 patients, there were 354 patients with diagnosis of SHF, a prevalence of 2.4%. The incidence of AF on ECG was 109 (31%) patients in the whole study population and 245 (69%) in SR. M Mode echocardiogram in patients with SHF and AF compared with those in SR showed significant dilation of LV cavity in systole with LVESD of 5.72 ± 0.63 vs. 5.23 ± 0.76 cm, P < 0.001 and in Diastole LVEDD of 6.83 ± 0.51 vs. 6.58 ± 0.63 cm, P < 0.001. Pulsed Doppler echocardiogram showed a severe restrictive-pattern with shorter Decellration Time (DT) of 163.73 ± 7.42 vs. 214.9 ± 31.81msec, P < 0.001 and higher Pulse to Tissue Doppler ratio of E/Em of 14.26 ± 1.34 vs. 9.99 ± 1.27, P < 0.001, and the serum level of Brain Natriuretic Peptide (BNP) hormone of 723.72 ± 13.45 vs. 686.98 ± 72.57 pg/ml, P < 0.001. The predictive risks (odd ratio) of different clinical variables for the development of AF in SHF were positive for high BNP > 500 pg/ml of 2.8, history of hypertension of 1.8, history of DM of 1.7, BMI > 28 of 1.4, LV hypertrophy on ECG of 1.3. Conclusions: The prevalence of Systolic Heart Failure in the study population was 2.4%. The prevalence of AF in the study population was 31%. The best predictors of AF in SHF were high BNP > 500 pg/ml, history of hypertension, Diabete Mellitus and LV Hypertrophy on ECG.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

S. Gabani, T. Garadah, A. Hassan, A. Jaradat, M. Al Alawi and Z. Hasan, "Prevalence of Atrial Fibrillation in Systolic Heart Failure, Pulsed and Tissue Doppler Echocardiographic Abnormalities," International Journal of Clinical Medicine, Vol. 4 No. 11, 2013, pp. 504-509. doi: 10.4236/ijcm.2013.411089.

References

[1] V. L. Roger, “The Heart Failure Epidemic,” International Journal of Environmental Research and Public Health, Vol. 7, No. 4, 2010, pp. 1807-1830.
http://dx.doi.org/10.3390/ijerph7041807
[2] S. A. Hunt, W. T. Abraham, M. H. Chin, et al., “2009 Focused Update Incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration with the International Society for Heart and Lung Transplantation,” Circulation, Vol. 119, No. 14, 2009, pp. e391-479. http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192065
[3] K. Dickstein, A. Cohen-Solal, G. Filippatos, et al., “ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and Endorsed by the European Society of Intensive Care Medicine (ESICM),” European Heart Journal, Vol. 29, No. 19, 2008, pp. 2388-2442.
http://dx.doi.org/10.1093/eurheartj/ehn309
[4] J. P. Bounhoure, P. Massabuau, M. Galinier, et al., “Heart Failure with Preserved Left Ventricular Function: Clinical, Echocardiographic, and Clinical Course Features. Prognostic Factors,” Bulletin of the National Academy of Medicine, Vol. 186, No. 6, 2002, pp. 1013-1014.
[5] R. Nagarakanti and M. Ezekowitz, “Diastolic Dysfunction and Atrial Fibrillation,” Journal of Interventional Cardiac Electrophysiology, Vol. 22, No. 2, 2008, pp. 111-118. http://dx.doi.org/10.1007/s10840-008-9203-8
[6] E. J. Benjamin, D. Levy, S. M. Vaziri, et al., “Independent Risk Factors for Atrial Fibrillation in a Population-Based Cohort. The Framingham Heart Study,” JAMA, Vol. 271, No. 11, 1994, pp. 840-844.
http://dx.doi.org/10.1001/jama.1994.03510350050036
[7] R. Nieuwlaat, L. W. Eurlings, J. G. Cleland, et al., “Atrial Fibrillation and Heart Failure in Cardiology Practice: Reciprocal Impact and Combined Management from the Perspective of Atrial Fibrillation: Results of the Euro Heart Survey on atrial fibrillation,” Journal of the American College of Cardiology , Vol. 53, No. 18, 2009, pp. 1690-1698.
http://dx.doi.org/10.1016/j.jacc.2009.01.055
[8] J. G. Cleland, K. Swedberg, F. Follath, et al., “The EuroHeart Failure Survey Programme—A Survey on the Quality of Care among Patients with Heart Failure in Europe. Part 1: Patient Characteristics and Diagnosis,” European Heart Journal, Vol. 24, No. 5, 2003, pp. 442-463. http://dx.doi.org/10.1016/S0195-668X(02)00823-0
[9] A. J. Camm and I. Savelieva, “Atrial Fibrillation: Advances and Perspectives,” Dialogues in Cardiovascular Medicine, Vol. 8, 2003, pp. 183-202.
[10] S. Yusuf, M. A. Pfeffer, K. Swedberg, et al., “Effects of Candesartan in Patients with Chronic Heart Failure and Preserved Left-Ventricular Ejection Fraction: The CHARM-Preserved Trial,” Lancet, Vol. 362, No. 9386, 2003, pp. 777-781.
http://dx.doi.org/10.1016/S0140-6736(03)14285-7
[11] M. Klapholz, M. Maurer, A. M. Lowe, et al., “Hospitalization for Heart Failure in the Presence of a Normal Left Ventricular Ejection Fraction: Results of the New York Heart Failure Registry,” Journal of the American College of Cardiology, Vol. 43, No. 8, 2004, pp. 1432-1438.
http://dx.doi.org/10.1016/j.jacc.2003.11.040
[12] K. Dickstein, “Natriuretic Peptides in Detection of Heart Failure,” Lancet, Vol. 351, No. 9095, 1998, p. 4.
http://dx.doi.org/10.1016/S0140-6736(05)78100-9
[13] A. S. Maisel, P. Krishnaswamy, R. M. Nowak, et al., “Rapid Measurement of B-Type Natriuretic Peptide in the Emergency Diagnosis of Heart Failure,” The New England Journal of Medicine, Vol. 347, No. 3, 2002, pp. 161-167. http://dx.doi.org/10.1056/NEJMoa020233
[14] K. Dickstein, A. Cohen-Solal, G. Filippatos, et al., “ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM),” European Journal of Heart Failure, Vol. 10, No. 10, 2008, pp. 933-989.
http://dx.doi.org/10.1016/j.ejheart.2008.08.005
[15] P. Verdecchia, G. Schillaci, C. Borgioni, et al., “Prognostic Value of a New Electrocardiographic Method for Diagnosis of Left Ventricular Hypertrophy in Essential Hypertension,” Journal of the American College of Cardiology , Vol. 31, No. 2, 1998, pp. 383-390.
http://dx.doi.org/10.1016/S0735-1097(97)00493-2
[16] A. S. Go, E. M. Hylek, K. A. Phillips, et al., “Prevalence of Diagnosed Atrial Fibrillation in Adults: National Implications for Rhythm Management and Stroke Prevention: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study,” JAMA, Vol. 285, No. 18, 2001, pp. 2370-2375.
http://dx.doi.org/10.1001/jama.285.18.2370
[17] D. J. Sahn, A. DeMaria, J. Kisslo, et al., “Recommendations regarding Quantitation in M-Mode Echocardiography: Results of a Survey of Echocardiographic Measurements,” Circulation, Vol. 58, No. 6, 1978, pp. 1072-1083.
http://dx.doi.org/10.1161/01.CIR.58.6.1072
[18] N. B. Schiller, H. Acquatella, T. A. Ports, et al., “Left Ventricular Volume from Paired Biplane Two-Dimensional Echocardiography,” Circulation, Vol. 60, No. 3, 1979, pp. 547-555.
http://dx.doi.org/10.1161/01.CIR.60.3.547
[19] R. M. Lang, M. Bierig, R. B. Devereux, et al., “Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology,” Journal of the American Society of Echocardiography, Vol. 18, No. 12, 2005, pp. 1440-1463.
http://dx.doi.org/10.1016/j.echo.2005.10.005
[20] J. D. F. Cleland, E. Erdmann, R. Ferrari, et al., “Guidelines for the Diagnosis of Heart Failure. The Task Force on Heart Failure of the European Society of Cardiology,” European Heart Journal, Vol. 16, No. 6, 1995, pp. 741-751.
[21] S. F. Nagueh, C. P. Appleton, T. C. Gillebert, et al., “Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography,” European Journal of Echocardiography, Vol. 10, No. 2, 2009, pp. 165-193. http://dx.doi.org/10.1093/ejechocard/jep007
[22] M. J. Koren, R. B. Devereux, P. N. Casale, et al., “Relation of Left Ventricular Mass and Geometry to Morbidity and Mortality in Uncomplicated Essential Hypertension,” Annals of Internal Medicine, Vol. 114, No. 5, 1991, pp. 345-352. http://dx.doi.org/10.7326/0003-4819-114-5-345
[23] B. M. Massie and N. B. Shah, “Evolving Trends in the Epidemiologic Factors of Heart Failure: Rationale for Preventive Strategies and Comprehensive Disease Management,” American Heart Journal, Vol. 133, No. 6, 1997, pp. 703-712.
http://dx.doi.org/10.1016/S0002-8703(97)70173-X
[24] F. Ceia, C. Fonseca, T. Mota, et al., “Prevalence of Chronic Heart Failure in Southwestern Europe: The EPICA Study,” European Journal of Heart Failure, Vol. 4, No. 4, 2002, pp. 531-539.
http://dx.doi.org/10.1016/S1388-9842(02)00034-X
[25] G. F. Mureddu, N. Agabiti, V. Rizzello, et al., “Prevalence of Preclinical and Clinical Heart Failure in the Elderly. A Population-Based Study in Central Italy,” European Journal of Heart Failure, Vol. 14, No. 7, 2012, pp. 718-729. http://dx.doi.org/10.1093/eurjhf/hfs052
[26] J. G. Cleland, A. Khand and A. Clark, “The Heart Failure Epidemic: Exactly How Big Is It?” European Heart Journal, Vol. 22, No. 8, 2001, pp. 623-626.
http://dx.doi.org/10.1053/euhj.2000.2493
[27] J. Grewal, R. S. McKelvie, H. Persson, et al., “Usefulness of N-Terminal Pro-Brain Natriuretic Peptide and Brain Natriuretic Peptide to Predict Cardiovascular Outcomes in Patients with Heart Failure and Preserved Left Ventricular Ejection Fraction,” American Journal of Cardiology, Vol. 102, No. 6, 2008, pp. 73373-73377.
http://dx.doi.org/10.1016/j.amjcard.2008.04.048
[28] S. J. Phillips, J. P. Whisnant, W. M. O’Fallon, et al., “Prevalence of Cardiovascular Disease and Diabetes Mellitus in Residents of Rochester, Minnesota,” Mayo Clinic Proceedings, Vol. 65, No. 3, 1990, pp. 344-359.
http://dx.doi.org/10.1016/S0025-6196(12)62535-X
[29] F. Bursi, S. A. Weston, M. M. Redfield, et al., “Systolic and Diastolic Heart Failure in the Community,” JAMA, Vol. 296, No. 18, 2006, pp. 2209-2216.
http://dx.doi.org/10.1001/jama.296.18.2209
[30] N. Ilksoy, M. Hoffman, R. H. Moore, et al., “Comparison of African-American Patients with Systolic Heart Failure versus Preserved Ejection Fraction,” American Journal of Cardiology, Vol. 98, No. 6, 2006, pp. 806-808.
http://dx.doi.org/10.1016/j.amjcard.2006.03.066
[31] E. P. Havranek, F. A. Masoudi, K. A. Westfall, et al., “Spectrum of Heart Failure in Older Patients: Results from the National Heart Failure Project,” American Heart Journal, Vol. 143, No. 3, 2002, pp. 412-417.
http://dx.doi.org/10.1067/mhj.2002.120773
[32] J. I. Haft and L. E. Teichholz, “Echocardiographic and clinical risk factors for atrial fibrillation in hypertensive patients with ischemic stroke,” American Journal of Cardiology, Vol. 102, No. 10, 2008, pp. 1348-13451.
http://dx.doi.org/10.1016/j.amjcard.2008.07.009
[33] F. L. Dini, U. Conti, P. Fontanive, et al., “Prognostic Value of N-Terminal Pro-Type-B Natriuretic Peptide and Doppler Left Ventricular Diastolic Variables in Patients with Chronic Systolic Heart Failure Stabilized by Therapy,” American Journal of Cardiology, Vol. 102, No. 4, 2008, pp. 463-468.
http://dx.doi.org/10.1016/j.amjcard.2008.03.083
[34] B. Al-Aloul, J. M. Li, D. Benditt, et al., “Atrial fibrillation Associated with hypokalemia due to Primary Hyperaldosteronism (Conn’s Syndrome),” Pacing and Clinical Electrophysiology, Vol. 29, No. 11, 2006, pp. 1303-1305.
http://dx.doi.org/10.1111/j.1540-8159.2006.00536.x
[35] E. J. Topol, T. A. Traill and N. J. Fortuin, “Hypertensive Hypertrophic Cardiomyopathy of the Elderly,” The New England Journal of Medicine, Vol. 312, No. 5, 1985, pp. 277-283.
http://dx.doi.org/10.1056/NEJM198501313120504
[36] J. S. Shinbane, M. A. Wood, D. N. Jensen, et al., “Tachycardia-Induced Cardiomyopathy: A Review of Animal Models and Clinical Studies,” Journal of the American College of Cardiology , Vol. 29, No. 4, 1997, pp. 709-715.
http://dx.doi.org/10.1016/S0735-1097(96)00592-X
[37] M. M. Redfield, G. N. Kay, L. S. Jenkins, et al., “Tachycardia-Related Cardiomyopathy: A Common Cause of Ventricular Dysfunction in Patients with Atrial Fibrillation Referred for Atrioventricular Ablation,” Mayo Clinic Proceedings, Vol. 75, No. 8, 2000, pp. 790-795.
http://dx.doi.org/10.4065/75.8.790

  
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