Heart Failure Subtypes and Thromboembolic Risk in Patients with Atrial Fibrillation: The PREFER in AF - HF substudy

0489777 - ÚI 2019 RIV IE eng J - Článek v odborném periodiku
Siller-Matula, J. M. - Pecen, Ladislav - Patti, G. - Lucerna, M. - Kirchhof, P. - Lesiak, M. - Huber, K. - Verheugt, F. W. A. - Lang, I. - Renda, G. - Schnabel, R. B. - Wachter, R. - Kotecha, D. - Sellal, J.-M. - Rohla, M. - Ricci, F. - De Caterina, R.
Heart Failure Subtypes and Thromboembolic Risk in Patients with Atrial Fibrillation: The PREFER in AF - HF substudy.
International Journal of Cardiology. Roč. 265, August (2018), s. 141-147. ISSN 0167-5273. E-ISSN 1874-1754
Institucionální podpora: RVO:67985807
Klíčová slova: Atrial fibrillation * Bleeding * Ejection fraction * Heart failure * Stroke
Obor OECD: Cardiac and Cardiovascular systems
Impakt faktor: 3.471, rok: 2018

BACKGROUND AND OBJECTIVES: To assess thromboembolic and bleeding risks in patients with heart failure (HF) and atrial fibrillation (AF) according to HF type. METHODS: We analyzed 6170 AF patients from the Prevention of thromboembolic events - European Registry in Atrial Fibrillation (PREFER in AF), and categorized patients into: HF with reduced left-ventricular ejection fraction (HFrEF, LVEF < 40%), mid-range EF (HFmrEF, LVEF: 40-49%), lower preserved EF (HFLpEF, LVEF: 50-60%), higher preserved EF (HFHpEF, LVEF > 60%), and no HF. Outcomes were ischemic stroke, major adverse cardiovascular and cerebral events (MACCE) and major bleeding occurring within 1-year. RESULTS: The annual incidence of stroke was linearly and inversely related to LVEF, increasing by 0.054% per each 1% of LVEF decrease (95% CI: 0.013%-0.096%, p = 0.031). Patients with HFHpEF had the highest CHA2DS2-VASc score, but significantly lower stroke incidence than other HF groups (0.65%, compared to HFLpEF 1.30%, HFmrEF 1.71%, HFrEF 1.75%, trend p = 0.014). The incidence of MACCE was also lower in HFHpEF (2.0%) compared to other HF groups (range: 3.8-4.4%, p = 0.001). Age, HF type, and NYHA class were independent predictors of thromboembolic events. Conversely, major bleeding did not significantly differ between groups (p = 0.168). CONCLUSION: Our study in predominantly anticoagulated patients with AF shows that, reduction in LVEF is associated with higher thromboembolic, but not higher bleeding risk. HFHpEF is a distinct and puzzling group, featuring the highest CHA2DS2-VASc score but the lowest residual risk of thromboembolic events, which warrants further investigation.
Trvalý link: http://hdl.handle.net/11104/0284135