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

被引：11

作者：

Shah, Neeraj ^{[1
]}

Badheka, Apurva O. ^{[2
]}

Grover, Peeyush M. ^{[3
,4
]}

Patel, Nileshkumar J. ^{[1
]}

Chothani, Ankit ^{[5
]}

Mehta, Kathan ^{[6
]}

Hoosien, Michael ^{[3
,4
]}

Singh, Vikas ^{[3
,4
]}

Savani, Ghanshyambhai T. ^{[3
,4
]}

Deshmukh, Abhishek ^{[7
]}

Rathod, Ankit ^{[8
]}

Patel, Nilay ^{[2
]}

Panaich, Sidakpal S. ^{[2
]}

Arora, Shilpkumar ^{[2
]}

Schwartz, Charles ^{[1
]}

Blisker, Martin ^{[3
,4
]}

Coffey, James O. ^{[3
,4
]}

Mitrani, Raul D. ^{[3
,4
]}

Fuster, Valentin ^{[9
]}

Viles-Gonzalez, Juan F. ^{[3
]}

机构：

[1] Staten Isl Univ Hosp, Staten Isl, NY USA

[2] Detroit Med Ctr, Detroit, MI USA

[3] Univ Miami, Miller Sch Med, Miami, FL 33136 USA

[4] Jackson Mem Hosp, Miami, FL 33136 USA

[5] Washington Hosp Ctr, Washington, DC 20010 USA

[6] Drexel Univ, Sch Publ Hlth, Philadelphia, PA 19104 USA

[7] Univ Arkansas, Little Rock, AR 72204 USA

[8] Cedar Sinai Med Ctr, Los Angeles, CA USA

[9] Mt Sinai Med Ctr, New York, NY 10029 USA

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2014年 / 174卷 / 02期

关键词：

Left ventricular hypertrophy; Atrial fibrillation; Rhythm control; Hospitalization; MANAGEMENT AFFIRM; HYPERTROPHY; DISEASE; ECHOCARDIOGRAPHY; QUANTIFICATION; MECHANISMS; SIZE;

D O I：

10.1016/j.ijcard.2014.04.011

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 13.3 months (95% CI 8.2-24.5) vs. 28.3 months (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 (1.041.78, 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. (c) 2014 Elsevier Ireland Ltd. All rights reserved.

引用

页码：288 / 292

页数：5

共 16 条

[1] ESTIMATION OF LEFT-VENTRICULAR FILLING PRESSURES USING 2-DIMENSIONAL AND DOPPLER-ECHOCARDIOGRAPHY IN ADULT PATIENTS WITH CARDIAC DISEASE - ADDITIONAL VALUE OF ANALYZING LEFT ATRIAL SIZE, LEFT ATRIAL EJECTION FRACTION AND THE DIFFERENCE IN DURATION OF PULMONARY VENOUS AND MITRAL FLOW VELOCITY AT ATRIAL CONTRACTION [J].