ABSTRACT
Objectives : Systolic and diastolic dysfunctions are related to
adverse clinical outcomes in patients with sinus rhythm. The aim of this
study was to clarify the prognostic significance of systolic and
diastolic dysfunctions in patients with chronic persistent atrial
fibrillation (AF).
Methods : We evaluated data for 114 consecutive patients with
chronic AF who underwent measurement of LVEDP at our hospital between 1
March 2011 and 31 December 2014. In total, 114 consecutive patients with
chronic AF were divided into two groups according to the left
ventricular ejection fraction (LVEF): LVEF < 50 (reduced
ejection fraction, REF group) and LVEF ≥50 (preserved EF, PEF group).
The PEF group was further divided into two subgroups according to the
left ventricular end-diastolic filling pressure (LVEDP): LVEDP
>15 mmHg and LVEDP ≤ 15 mmHg. The 3-year clinical outcomes
were compared between the PEF and REF groups and the LVEDP ≥15 mmHg and
LVEDP <15 mmHg groups.
Results : During the 3-year follow-up period, the rate of heart
failure (HF) hospitalisation and incidence of AF with rapid ventricular
rhythm (RVR) were higher in the REF group than in the PEF group.
Multivariate analysis revealed that REF was the only significant
predictor of HF hospitalisation (hazard ratio, 4.71; 95% confidence
interval, 1.48–15.02; p=0.009).
Conclusions : Our observations during a mid-term follow-up
period revealed that systolic dysfunction could be an important
predictor of HF hospitalisation in patients with AF. However, elevated
LVEDP may not be associated with mid-term adverse clinical outcomes in
patients without systolic dysfunction.