Management of Atrial Fibrillation Across the Spectrum of Heart Failure With Preserved and Reduced Ejection Fraction

Reddy, Yogesh N.V.; Borlaug, Barry A.; Gersh, Bernard J.

doi:10.1161/circulationaha.122.057444

Cited by 46 publications

(24 citation statements)

References 106 publications

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“…In the previous study, however, these parameters were less severe in patients with NDLVC–REF than in those with DCM. Both AF and elevated LV filling pressure are known clinical risk factors associated with cardiac events in patients with HF 16,17 . This makes the risk of cardiac events in patients with NDLVC–REF comparable with those with DCM in the current study.…”

Section: Discussionmentioning

confidence: 67%

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Non‐dilated left ventricular cardiomyopathy vs. dilated cardiomyopathy: clinical background and outcomes

Eda,

Nabeta,

Iikura

et al. 2024

ESC Heart Failure

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AimsNon‐dilated left ventricular cardiomyopathy (NDLVC) was proposed as a new category of cardiomyopathy that included patients with non‐left ventricular (LV) dilatation, LV wall motion abnormality, or LV scar. However, the clinical background and event rates of NDLVC were unclear. The aim of this study was to examine the characteristics and event rates of patients with NDLVC and reduced LV ejection fraction (NDLVC–REF) in comparison with those with dilated cardiomyopathy (DCM).Methods and resultsWe retrospectively included 363 patients with newly diagnosed non‐ischaemic cardiomyopathy and reduced LV ejection fraction (<50%) between December 2004 and January 2018. Patients who did not have LV dilatation (LV dimension index of ≦31 mm/m2 in men and ≦34 mm/m2 in women) were categorized as NDLVC–REF (n = 80, 22.2%), and the remaining patients were categorized as DCM. Cardiac events were defined as sudden cardiac death and rehospitalization for heart failure. Patients with NDLVC–REF had a higher prevalence of atrial fibrillation and a higher LV ejection fraction than those with DCM at baseline. LV ejection fraction was higher and LV end‐diastolic diameter was smaller in patients with NDLVC–REF than in those with DCM at all time points after diagnosis. During the median follow‐up period of 68.8 months (interquartile range: 33.0–93.7 months), 44 patients experienced cardiac events. The Kaplan–Meier curves showed no significant differences in the probability of cardiac events among NDLVC–REF and DCM patients (P = 0.349). However, patients with NDLVC–REF and LV dilatation after diagnosis (14%) had a higher risk of cardiac events than those with NDLVC–REF without LV dilatation (P = 0.049).ConclusionsThere was no significant difference in the incidence of cardiac events between NDLVC–REF and DCM. Among NDLVC–REF patients, 18% of patients who showed LV dilatation after diagnosis had poor outcomes. Therefore, both NDLVC–REF and DCM patients may require equivalent attention to follow‐up and regular assessment of LV function.

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Section: Discussionmentioning

confidence: 67%

“…Both AF and elevated LV filling pressure are known clinical risk factors associated with cardiac events in patients with HF. 16,17 This makes the risk of cardiac events in patients with NDLVC-REF comparable with those with DCM in the current study.…”

Section: Characteristics and Outcomes In Non-dilated Left Ventricular...mentioning

confidence: 67%

Non‐dilated left ventricular cardiomyopathy vs. dilated cardiomyopathy: clinical background and outcomes

Eda,

Nabeta,

Iikura

et al. 2024

ESC Heart Failure

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“…[77][78][79] The use of SGLT2i has also been associated with reduced incident AF, which may, in part, be due to the reduction in epicardial fat. 80,81 The diuretic effect of SGLT2i may facilitate a reduction in plasma volume and mechanistic studies have shown that they also promote ventricular mass regression, which may cumulatively decrease pericardial restraint. 77,82,83 Likely, in part, through these mechanisms, SGLT2i have demonstrated haemodynamic benefits on PCWP at rest and exercise in systolic heart failure and HFpEF (NCT04730947).…”

Section: Is Eat Merely a Marker Of Functionally Severe Obesity In Hfpef?mentioning

confidence: 99%

Epicardial Fat in Heart Failure with Preserved Ejection Fraction: Bad Actor or Just Lying Around?

2023

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Heart failure with preserved ejection fraction (HFpEF) is increasingly recognised to be strongly associated with obesity and abnormalities in fat distribution. Epicardial fat has been associated with abnormal haemodynamics in HFpEF, with potential for direct mechanical effects on the heart causing constriction-like physiology and local myocardial remodelling effects from secretion of inflammatory and profibrotic mediators. However, patients with epicardial fat generally have more systemic and visceral adipose tissue making determination of causality between epicardial fat and HFpEF complex. In this review, we will summarise the evidence for epicardial fat being either directly causal in HFpEF pathogenesis or merely being a correlate of worse systemic inflammatory and generalised adiposity. We will also discuss therapies that directly target epicardial fat and may have potential for treating HFpEF and elucidating the independent role of epicardial fat in its pathogenesis.

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“…It is associated with higher rates of stroke, heart failure (HF), hospital admissions, and mortality, thus representing an important medical challenge ( 4 ). Common conditions such as ischemic heart disease and HF with either reduced ejection fraction (EF) or preserved EF (HFrEF and HFpEF, respectively) are important etiological factors for AF ( 5 , 6 ), and they converge together with additional etiological factors such as hypertension, obesity, diabetes mellitus, and sleep apnea to increase the risk of AF in ways that remain elusive ( 7 ). AF is a progressive condition that results in a greater risk of recurrence and persistence over time, complicating treatment efforts ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

The SK4 channel allosteric blocker, BA6b9, reduces atrial fibrillation substrate in rats with reduced ejection fraction

Burg,

Levi,

Elyagon

et al. 2024

PNAS Nexus

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Atrial fibrillation (AF), the most common cardiac arrhythmia, is strongly associated with several comorbidities including heart failure (HF). AF in general, and specifically in the context of HF, is progressive in nature and associated with poor clinical outcomes. Current therapies for AF are limited in number and efficacy and do not target the underlying causes of atrial remodeling such as inflammation or fibrosis. We previously identified the calcium-activated SK4 K+ channels, which are preferentially expressed in the atria relative to the ventricles in both rat and human hearts, as novel druggable target for AF treatment. Here we examined the ability of BA6b9, a novel allosteric inhibitor of SK4 channels that targets the specific calmodulin-PIP2 binding domain, to alter AF susceptibility and atrial remodeling in a systolic HF rat post-myocardial infarction (post-MI) model. Daily BA6b9 injection (20 mg/kg/day) for 3 weeks starting 1-week post-MI prolonged the atrial effective refractory period, reduced AF induction and duration, and dramatically prevented atrial structural remodeling. In the post-MI left atrium (LA), pronounced upregulation of the SK4 K+ channel was observed, with corresponding increases in collagen deposition, α-SMA levels, and NLRP3 inflammasome expression. Strikingly, BA6b9 treatment reversed these changes while also significantly reducing the lateralization of the atrial connexin Cx43 in the LA of post-MI rats. Our findings indicate that the blockade of SK4 K+ channels using BA6b9 not only favors rhythm control but also remarkably reduces atrial structural remodeling, a property that is highly desirable for novel AF therapies, particularly in patients with comorbid HF.

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Management of Atrial Fibrillation Across the Spectrum of Heart Failure With Preserved and Reduced Ejection Fraction

Cited by 46 publications

References 106 publications

Non‐dilated left ventricular cardiomyopathy vs. dilated cardiomyopathy: clinical background and outcomes

Non‐dilated left ventricular cardiomyopathy vs. dilated cardiomyopathy: clinical background and outcomes

Epicardial Fat in Heart Failure with Preserved Ejection Fraction: Bad Actor or Just Lying Around?

The SK4 channel allosteric blocker, BA6b9, reduces atrial fibrillation substrate in rats with reduced ejection fraction

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