Impact of stroke volume on prognostic outcome in patients with atrial fibrillation and concomitant heart failure with preserved ejection fraction

Abstract

A B S T R A C TBackground: Atrial fibrillation (AF) can lead to a decrease in stroke volume (SV) despite a preserved left ventricular ejection fraction (LVEF). However, no previous studies have evaluated the prognostic importance of the decreased SV in patients with AF and concomitant heart failure with preserved ejection fraction (HFpEF). Methods: We retrospectively studied the cases of 1520 consecutive patients who had undergone right heart catheterization. HFpEF (New York Heart Association functional class !II and LVEF !50%) was observed in 574 patients. We selected 47 patients with persistent AF with a heart rate of 40-110 bpm and HFpEF without other underlying heart diseases. Results: Among a total of 47 patients, 16 (34%) had normal SV [SV index (SVI) >35 ml/m 2 and 31 (66%) patients had low SV (SVI 35 ml/m 2 )]. During the follow-up period of 1115 AE 305 days, 14 patients (30%) met the composite endpoint defined as cardiac death and admission due to worsening heart failure. Cox proportional hazard ratio analysis showed that SVI was a predictor of the endpoint, independently of the cardiac index and other parameters. Kaplan-Meyer analysis showed that low SVI was significantly associated with a poor prognosis, with an event-free rate of 58% at the mean follow-up period of 991 days (log-rank p = 0.02). In the multiple regression analysis, a high systemic vascular resistance index and a high heart rate were independent determinants of low SVI. Conclusions: Our findings suggest that low SV had a significant impact on prognosis in patients with AF despite the preserved LVEF. The SVI depended on the heart rate and SVRI.

Impact of Cardiac Function on Loss of Patency in Patients With Peripheral Artery Disease Presenting the Femoropopliteal Lesions Endovascularly Treated With New-Generation Devices

“…However, 12-month difference was neither spread nor attenuated, meaning SV might not be a predictive factor for loss of primary patency after 12 months. Although reduced SV was reported to be significantly associated with cardiac death and hospitalizations due to worsening heart failure at the mean follow-up period of 991 days on the Kaplan-Meier analysis, 23 the current study revealed the incidences of MACE, including cardiac death, and hospitalizations were not significantly different between the 2 groups at 12 months. The impact of SV on prognostic outcome in PAD patients might be established by performing a longer follow-up.…”

Long‐term predictive value of stroke volume index obtained from right heart catheterization: Insights from the veterans affairs clinical assessment, reporting, and tracking program

“…Low stroke volume and low cardiac power has been associated with high short‐term risk across multiple cardiac and noncardiac conditions including cirrhosis, pulmonary hypertension, severe aortic stenosis, acute heart failure, and cardiogenic shock 1,3,6,17‐22 . The present study adds to the existing literature by assessing the long‐term prognostic implications of right heart catheterization‐derived hemodynamic parameters.…”

Combination of SVI/S′ and diagnostic scores for heart failure with preserved ejection fraction

“…Despite the normal LVEF, invasive hemodynamic or echocardiographic measured stroke volume may be impaired in HFpEF patients 29,30 . In our previous study, SVI/S′ was well used for both diagnosis and prognosis in HFpEF 31 .…”

“…Despite the normal LVEF, invasive hemodynamic or echocardiographic measured stroke volume may be impaired in HFpEF patients. 29,30 In our previous study, SVI/S 0 was well used for both diagnosis and prognosis in HFpEF. 31 With a cut-off value of 4.08, an AUC of 0.761 for SVI/S 0 was obtained with a sensitivity of 80% and specificity of 64%.…”