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Impact of left ventricular diastolic function and direct oral anticoagulant use for predicting embolic events in patients with heart failure and atrial fibrillation.
Yamamoto, Jumpei; Hayama, Hiromasa; Enomoto, Yoshinari; Yamamoto, Masaya; Hara, Hisao; Hiroi, Yukio.
Afiliación
  • Yamamoto J; Department of Cardiology National Center for Global Health and Medicine Tokyo Japan.
  • Hayama H; Department of Cardiology National Center for Global Health and Medicine Tokyo Japan.
  • Enomoto Y; Department of Cardiology National Center for Global Health and Medicine Tokyo Japan.
  • Yamamoto M; Department of Cardiology National Center for Global Health and Medicine Tokyo Japan.
  • Hara H; Department of Cardiology National Center for Global Health and Medicine Tokyo Japan.
  • Hiroi Y; Department of Cardiology National Center for Global Health and Medicine Tokyo Japan.
J Arrhythm ; 40(3): 489-500, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38939759
ABSTRACT

Background:

Patients with atrial fibrillation (AF) and heart failure (HF) have high stroke risk owing to left atrial dysfunction. However, anticoagulation is a concern in patients with high bleeding risk. We aimed to identify independent predictors of stroke in HF patients with AF.

Methods:

We retrospectively examined 320 patients (mean age 79 ± 12 years, 163 women) hospitalized with acute HF complicated by AF between January 2014 and December 2018. Patients were followed from admission until ischemic stroke or systemic embolism (SSE) onset or death or were censored at the last contact date or September 2023.

Results:

SSE occurred in 40 patients (median follow-up of 528 days). Multivariate Cox regression analysis identified age (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.00-1.07, p = .034), direct oral anticoagulant (DOAC) use (HR 0.26, 95% CI 0.11-0.60, p = .002), and early diastolic peak flow velocity to early diastolic peak annular velocity (E/e'; HR 1.05, 95% CI 1.02-1.08, p < .001) to be independent predictors of SSE, whereas left atrial reservoir strain was not. After determining an appropriate E/e' cutoff by receiver-operating characteristic curve analysis and adjusting the multivariate Cox model, E/e' ≥17.5 (HR 3.30, 95% CI 1.56-6.83, p = .001) independently predicted SSE. The results were consistent with no interaction in the subanalysis except for gender.

Conclusion:

Elderly patients not on DOACs with elevated E/e' may be at higher risk of stroke, suggesting that DOACs should be the first choice for patients with elevated E/e' and aggressive additional prophylaxis and careful follow-up are needed.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Arrhythm Año: 2024 Tipo del documento: Article Pais de publicación: Japón
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Arrhythm Año: 2024 Tipo del documento: Article Pais de publicación: Japón