Skip to main content
SpringerLink
Log in

Outcome prediction in heart failure with atrial fibrillation: Relative role of left ventricular ejection fraction and neurohormonal measures

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Since atrial fibrillation (AF) impacts the measurement and interpretation of left ventricular ejection fraction (LVEF), we hypothesized that the outcome in heart failure (HF) with AF and LVEF ≤ 35% would be more strongly associated with neurohormonal measures than LVEF.

Methods and Results

Cardiac adverse events [CAE; HF progression (HFP), life-threatening arrhythmia (ARR), and cardiac death (CD)] and all-cause mortality (ACM) were recorded prospectively in 954 patients with HF and LVEF ≤ 35%: 852 in sinus rhythm (SR) and 102 in AF. Cox proportional hazard models found that the univariate hazard ratios (HR) for LVEF and the first CAE (primary outcome), HFP, ARR, CD, and ACM were significant in SR (0.933, P < .001, 0.933, P < .001, 0.929, P < .001, 0.916, P < .001, 0.945, P = .001, respectively), but not in AF (1.002, P = .95, 1.060, P = .24, 0.922, P = .15, 0.885, P = .09, 0.932, P = .25). HRs for CAEs and ACM and one or more neurohormonal measures (iodine 123 m-iodobenzylguanidine cardiac parameters, B-type natriuretic peptide, and plasma norepinephrine) were significant in SR and AF. The multivariate models for the first CAE and HFP included neurohormonal measures and LVEF in SR and neurohormonal measures in AF.

Conclusions

In HF with LVEF ≤ 35% with AF, neurohormonal measures, but not LVEF, were related to outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. 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. Circulation 2009;119:e391-479.

    Article  PubMed  Google Scholar 

  2. Solomon SD, Anavekar N, Skali H, McMurray JJ, Swedberg K, Yusuf S, et al. Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation 2005;112:3738-44.

    Article  PubMed  Google Scholar 

  3. Jacobson AF, Senior R, Cerqueira MD, Wong ND, Thomas GS, Lopez VA, et al. Myocardial iodine-123 meta-iodobenzylguanidine imaging and cardiac events in heart failure: results of the prospective ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) study. J Am Coll Cardiol 2010;55:2212-21.

    Article  PubMed  Google Scholar 

  4. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). J Am Coll Cardiol 2008;51:e1-62.

    Article  PubMed  Google Scholar 

  5. Larned JM, Raja Laskar S. Atrial fibrillation and heart failure. Congest Heart Fail 2009;15:24-30.

    Article  PubMed  Google Scholar 

  6. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, 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. J Am Soc Echocardiogr 2005;18:1440-63.

    Article  PubMed  Google Scholar 

  7. Corbett JR, Akinboboye OO, Bacharach SL, Borer JS, Botvinick EH, DePuey EG, et al. Equilibrium radionuclide angiocardiography. J Nucl Cardiol 2006;13:e56-79.

    Article  PubMed  Google Scholar 

  8. Paul AK, Nabi HA. Gated myocardial perfusion SPECT: Basic principles, technical aspects, and clinical applications. J Nucl Med Technol 2004;32:179-87.

    PubMed  Google Scholar 

  9. Foley TA, Mankad SV, Anavekar NS, Bonnichsen CR, Morris MF, Miller TD, et al. Measuring left ventricular ejection fraction—Techniques and potential pitfalls. Eur Cardiol 2012;8:108-14.

    Google Scholar 

  10. Anter E, Jessup M, Callans DJ. Atrial fibrillation and heart failure: Treatment considerations for a dual epidemic. Circulation 2009;119:2516-25.

    Article  PubMed  Google Scholar 

  11. Gertz ZM, Raina A, Sagby L, Zado ES, Callans DJ, Marchlinski FE, et al. Evidence of atrial functional mitral regurgitation due to atrial fibrillation. J Am Coll Cardiol 2011;58:1474-81.

    Article  PubMed  Google Scholar 

  12. Jacobson AF, Lombard J, Banerjee G, Camici PG. 123I-mIBG scintigraphy to predict risk for adverse cardiac outcomes in heart failure patients: Design of two prospective multicenter international trials. J Nucl Cardiol 2009;16:113-21.

    Article  PubMed  Google Scholar 

  13. The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 1992;327:685-91.

    Article  Google Scholar 

  14. Olsson LG, Swedberg K, Ducharme A, Granger CB, Michelson EL, McMurray JJ, et al. Atrial fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction: Results from the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) program. J Am Coll Cardiol 2006;47:1997-2004.

    Article  PubMed  Google Scholar 

  15. Middlekauff HR, Stevenson WG, Stevenson LW. Prognostic significance of atrial fibrillation in advanced heart failure: A study of 390 patients. Circulation 1991;84:40-8.

    Article  PubMed  CAS  Google Scholar 

  16. Mamas MA, Caldwell JC, Chacko S, Garratt CJ, Fath-Ordoubadi F, Neyses L. A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur J Heart Fail 2009;11:676-83.

    Article  PubMed  Google Scholar 

  17. Hamaguchi S, Yokoshiki H, Kinugawa S, Tsuchihashi-Makaya M, Yokota T, Takeshita A, et al. Effects of atrial fibrillation on long-term outcomes in patients hospitalized for heart failure in Japan: A report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J 2009;73:2084-90.

    Article  PubMed  CAS  Google Scholar 

  18. Crijns HJ, Tjeerdsma G, de Kam PJ, Boomsma F, van Gelder IC, van den Berg MP, et al. Prognostic value of the presence and development of atrial fibrillation in patients with advanced chronic heart failure. Eur Heart J 2000;21:1238-45.

    Article  PubMed  CAS  Google Scholar 

  19. Swedberg K, Olsson LG, Charlesworth A, Cleland J, Hanrath P, Komajda M, et al. Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: Results from COMET. Eur Heart J 2005;26:1303-8.

    Article  PubMed  CAS  Google Scholar 

  20. Carson PE, Johnson GR, Dunkman WB, Fletcher RD, Farrell L, Cohn JN, et al. The influence of atrial fibrillation on prognosis in mild to moderate heart failure: The V-HeFT Studies. Circulation 1993;87(Suppl):VI102-10.

    PubMed  CAS  Google Scholar 

  21. Roy D, Talajic M, Nattel S, Wyse DG, Dorian P, Lee KL, et al. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 2008;358:2667-77.

    Article  PubMed  CAS  Google Scholar 

  22. Nichols K, Yao SS, Kamran M, Faber TL, Cooke D, DePuey EG. Clinical impact of arrhythmias on gated SPECT cardiac myocardial perfusion and function assessment. J Nucl Cardiol 2001;8(1):19-30.

    Article  PubMed  CAS  Google Scholar 

  23. Parthenakis FI, Patrianakos AP, Skalidis EI, Diakakis GF, Zacharis EA, Chlouverakis G, et al. Atrial fibrillation is associated with increased neurohumoral activation and reduced exercise tolerance in patients with non-ischemic dilated cardiomyopathy. Int J Cardiol 2007;118:206-14.

    Article  PubMed  Google Scholar 

  24. Shah AM, Bourgoun M, Narula J, Jacobson AF, Solomon SD. Influence of ejection fraction on the prognostic value of sympathetic innervation imaging with iodine-123 MIBG in heart failure. J Am Coll Cardiol Imaging 2012;5:1139-46.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Ian P. Clements MD

  2. Division of Nuclear Medicine, Mayo Clinic, Rochester, MN, USA

    Gregory A. Wiseman MD

  3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    David O. Hodge MS

  4. GE Healthcare, Princeton, NJ, USA

    Arnold F. Jacobson MD, PhD

Authors
  1. Ian P. Clements MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregory A. Wiseman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David O. Hodge MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arnold F. Jacobson MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ian P. Clements MD.

Additional information

Funding

GE Healthcare provided funding for this analysis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Clements, I.P., Wiseman, G.A., Hodge, D.O. et al. Outcome prediction in heart failure with atrial fibrillation: Relative role of left ventricular ejection fraction and neurohormonal measures. J. Nucl. Cardiol. 20, 821–829 (2013). https://doi.org/10.1007/s12350-013-9751-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-013-9751-x

Keywords

Search

Navigation