Author + information
- Gang Huang, MD∗ (, )
- Junbo Xu, MD and
- Tingjie Zhang, MD
- ↵∗Cardiovascular and Metabolic Disease Center, The Second People’s Hospital of Chengdu, No. 10 Qinyunnan Street, Chengdu, Sichuan, China
The recently published work of Pandey et al. (1) provides us a new insight into the incident heart failure (HF) in real-world patients with atrial fibrillation (AF). It is reported that during a follow-up period of 2 years, 3.6% of overall AF patients had a HF event, 64% of those were with left ventricular ejection fraction (LVEF) preserved, and 13.5% with LVEF reduced.
In this study with 6,545 AF patients, there were about 40% persistent or permanent AF patients enrolled, and data about valve disease and left atrial/ventricle diameter are not available, although significant valve disease is identified as a risk factor for incident HF in subgroup analyses. However, in another study (2) that enrolled 9,974 AF patents from the same ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) cohort, about 25% had a significant valve disease history, including 11% with a valve replacement history. And the mean left atrial diameter was 4.4 cm in overall AF patients. These data could be likely partially comparable to data not reported in the current study by Pandey et al. (1).
The authors conclude most AF patents with incident HF were patients with preserved EF; however, the technique for LVEF evaluation used in this study was not mentioned. It is known to all that LVEF is affected by preload, afterload, heart rate, and dyssynchrony, as well as myocardial contractility (3). Furthermore, in several situations, LVEF values measured by transthoracic 2-dimensional echocardiography (modified Simpson's rule), which is the most widespread used technique for clinical evaluation of LVEF, can be inaccurate and unreproducible. In patients with persistent or permanent AF, accurate assessment of LV function is often difficult and unreliable because of the inherent beat-to-beat variability. In patients with valvular heart disease (especially mitral regurgitation, mitral stenosis, and aortic regurgitation), or with valve replacement, and/or with cardiac chamber enlargement, LVEF would be overestimated or underestimated (4). Therefore, there is a possibility to potentially overestimate the overall LVEF value in this study population.
In this work, it might be better to describe the potential bias from the LVEF measurement in the study population with different diseases.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
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- et al.
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