Is atrial fibrillation in HFpEF a distinct phenotype? Insights from multiparametric MRI and circulating biomarkers
Abstract Background Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) frequently co-exist. There is a limited understanding on whether this coexistence is associated with distinct alterations in myocardial remodelling and mechanics. We aimed to determine if patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) represent a distinct phenotype. Methods In this secondary analysis of adults with HFpEF (NCT03050593), participants were comprehensively phenotyped with stress cardiac MRI, echocardiography and plasma fibroinflammatory biomarkers, and were followed for the composite endpoint (HF hospitalisation or death) at a median of 8.5 years. Those with AF were compared to sinus rhythm (SR) and unsupervised cluster analysis was performed to explore possible phenotypes. Results 136 subjects were included (SR = 75, AF = 61). The AF group was older (76 ± 8 vs. 70 ± 10 years) with less diabetes (36% vs. 61%) compared to the SR group and had higher left atrial (LA) volumes (61 ± 30 vs. 39 ± 15 mL/m2, p < 0.001), lower LA ejection fraction (EF) (31 ± 15 vs. 51 ± 12%, p < 0.001), worse left ventricular (LV) systolic function (LVEF 63 ± 8 vs. 68 ± 8%, p = 0.002; global longitudinal strain 13.6 ± 2.9 vs. 14.7 ± 2.4%, p = 0.003) but higher LV peak early diastolic strain rates (0.73 ± 0.28 vs. 0.53 ± 0.17 1/s, p < 0.001). The AF group had higher levels of syndecan-1, matrix metalloproteinase-2, proBNP, angiopoietin-2 and pentraxin-3, but lower level of interleukin-8. No difference in clinical outcomes was observed between the groups. Three distinct clusters were identified with the poorest outcomes (Log-rank p = 0.029) in cluster 2 (hypertensive and fibroinflammatory) which had equal representation of SR and AF. Conclusions Presence of AF in HFpEF is associated with cardiac structural and functional changes together with altered expression of several fibro-inflammatory biomarkers. Distinct phenotypes exist in HFpEF which may have differing clinical outcomes..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
BMC Cardiovascular Disorders - 24(2024), 1, Seite 15 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Abhishek Dattani [VerfasserIn] |
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| Links: |
doi.org [kostenfrei] |
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| Themen: |
Atrial fibrillation |
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| doi: |
10.1186/s12872-024-03734-0 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
DOAJ092191460 |
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| 245 | 1 | 0 | |a Is atrial fibrillation in HFpEF a distinct phenotype? Insights from multiparametric MRI and circulating biomarkers |
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| 520 | |a Abstract Background Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) frequently co-exist. There is a limited understanding on whether this coexistence is associated with distinct alterations in myocardial remodelling and mechanics. We aimed to determine if patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) represent a distinct phenotype. Methods In this secondary analysis of adults with HFpEF (NCT03050593), participants were comprehensively phenotyped with stress cardiac MRI, echocardiography and plasma fibroinflammatory biomarkers, and were followed for the composite endpoint (HF hospitalisation or death) at a median of 8.5 years. Those with AF were compared to sinus rhythm (SR) and unsupervised cluster analysis was performed to explore possible phenotypes. Results 136 subjects were included (SR = 75, AF = 61). The AF group was older (76 ± 8 vs. 70 ± 10 years) with less diabetes (36% vs. 61%) compared to the SR group and had higher left atrial (LA) volumes (61 ± 30 vs. 39 ± 15 mL/m2, p < 0.001), lower LA ejection fraction (EF) (31 ± 15 vs. 51 ± 12%, p < 0.001), worse left ventricular (LV) systolic function (LVEF 63 ± 8 vs. 68 ± 8%, p = 0.002; global longitudinal strain 13.6 ± 2.9 vs. 14.7 ± 2.4%, p = 0.003) but higher LV peak early diastolic strain rates (0.73 ± 0.28 vs. 0.53 ± 0.17 1/s, p < 0.001). The AF group had higher levels of syndecan-1, matrix metalloproteinase-2, proBNP, angiopoietin-2 and pentraxin-3, but lower level of interleukin-8. No difference in clinical outcomes was observed between the groups. Three distinct clusters were identified with the poorest outcomes (Log-rank p = 0.029) in cluster 2 (hypertensive and fibroinflammatory) which had equal representation of SR and AF. Conclusions Presence of AF in HFpEF is associated with cardiac structural and functional changes together with altered expression of several fibro-inflammatory biomarkers. Distinct phenotypes exist in HFpEF which may have differing clinical outcomes. | ||
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Atrial fibrillation | |
| 650 | 4 | |a Cardiovascular magnetic resonance | |
| 650 | 4 | |a Biomarkers | |
| 650 | 4 | |a Phenotype | |
| 650 | 4 | |a Cluster analysis | |
| 653 | 0 | |a Diseases of the circulatory (Cardiovascular) system | |
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| 700 | 0 | |a Prathap Kanagala |e verfasserin |4 aut | |
| 700 | 0 | |a Svetlana Stoma |e verfasserin |4 aut | |
| 700 | 0 | |a Kelly S. Parke |e verfasserin |4 aut | |
| 700 | 0 | |a Anna-Marie Marsh |e verfasserin |4 aut | |
| 700 | 0 | |a Anvesha Singh |e verfasserin |4 aut | |
| 700 | 0 | |a Jayanth R. Arnold |e verfasserin |4 aut | |
| 700 | 0 | |a Alastair J. Moss |e verfasserin |4 aut | |
| 700 | 0 | |a Lei Zhao |e verfasserin |4 aut | |
| 700 | 0 | |a Mary Ellen Cvijic |e verfasserin |4 aut | |
| 700 | 0 | |a Matthew Fronheiser |e verfasserin |4 aut | |
| 700 | 0 | |a Shuyan Du |e verfasserin |4 aut | |
| 700 | 0 | |a Philippe Costet |e verfasserin |4 aut | |
| 700 | 0 | |a Peter Schafer |e verfasserin |4 aut | |
| 700 | 0 | |a Leon Carayannopoulos |e verfasserin |4 aut | |
| 700 | 0 | |a Ching-Pin Chang |e verfasserin |4 aut | |
| 700 | 0 | |a David Gordon |e verfasserin |4 aut | |
| 700 | 0 | |a Francisco Ramirez-Valle |e verfasserin |4 aut | |
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| 700 | 0 | |a Gaurav S. Gulsin |e verfasserin |4 aut | |
| 700 | 0 | |a Gerry P. McCann |e verfasserin |4 aut | |
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