Influence of left ventricular remodeling on atrial fibrillation recurrence and cardiovascular hospitalizations in patients undergoing rhythm-control therapy

Autor: Peeyush Grover, Michael Hoosien, Charles Schwartz, James O. Coffey, Shilpkumar Arora, Kathan Mehta, Neeraj Shah, Abhishek Deshmukh, Nileshkumar J. Patel, Apurva Badheka, Raul D. Mitrani, Sidakpal S. Panaich, Vikas Singh, Nilay Patel, Martin Blisker, Ankit Rathod, Juan F. Viles-Gonzalez, Valentin Fuster, Ankit Chothani, Ghanshyambhai T. Savani
Rok vydání: 2014
Předmět:
Zdroj: International Journal of Cardiology. 174:288-292
ISSN: 0167-5273
DOI: 10.1016/j.ijcard.2014.04.011
Popis: Background Atrial fibrillation (AF) patients with left ventricular hypertrophy (LVH) and diastolic dysfunction may derive benefit from being in sinus rhythm but no data are available to support this strategy in them. We sought to investigate effect of left ventricular remodeling on cardiovascular outcomes in AF patients undergoing rhythm control strategy. Methods We identified 1088 patients with echocardiographic data on left ventricular mass (LVM) enrolled in the AFFIRM trial. Using the American Society of Echocardiography (ASE) criteria, patients were divided into 4 categories: 1) normal geometry, 2) concentric remodeling, 3) eccentric hypertrophy, and 4) concentric hypertrophy. The primary endpoint was AF recurrence and the secondary endpoint was cardiovascular hospitalization (CVH). Results In rhythm control arm, median time to recurrence in patients with concentric LVH was 13.3months (95% CI 8.2–24.5) vs. 28.3months (95% CI 20.2–48.6) in patients without LVH. Concentric left ventricular hypertrophy (LVH) was independently predictive of AF recurrence (HR 1.49, 95% CI 1.10–2.01, p=0.01) in rhythm control arm, but not in overall population or rate control arm. Both concentric and eccentric LVH were independently predictive of cardiovascular hospitalization (CVH) in the overall population, with respective HRs of 1.36 (1.04–1.78, p=0.03) and 1.38 (1.02–1.85, p=0.04). Conclusion Concentric LVH is predictive of AF recurrences when a predominantly pharmacologic rhythm-control strategy is employed. Different patterns of LVH seem to be important determinants of outcomes (AF recurrence and CVH). These findings may have important clinical implications for the management of patients with AF and LVH. Further studies are warranted to confirm our findings.
Databáze: OpenAIRE