Prognostic Impact of Echocardiographic Congestion Grade in HFpEF With and Without Atrial Fibrillation

• DOI: 10.1016/j.jacasi.2021.10.012
• Publication Date: 2022-01-18T21:05:11Z
• Authors: Haruhiko Abe; Shumpei Kosugi; Tatsuhisa Ozaki; Tsuyoshi Mishima; Motoo Date; Yasunori Ueda; Masaaki Uematsu; Shunsuke Tamaki; Masamichi Yano; Takaharu Hayashi; Akito Nakagawa; Yusuke Nakagawa; Takahisa Yamada; Yoshio Yasumura; Tomoharu Dohi; Shinichiro Suna; Shungo Hikoso; Daisaku Nakatani; Yukihiro Koretsune; Yasushi Sakata
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Original Research; 3. Good health

Atrial fibrillation (AF) is common in heart failure with preserved ejection fraction (HFpEF).This study aimed to investigate the prognostic value of echocardiographic markers of congestion that can be applied to both AF and patients without AF with HFpEF.We conducted a multicenter study of 505 patients with HFpEF admitted to hospitals for acute decompensated heart failure. The ratio of early diastolic transmitral flow velocity to mitral annulus velocity (E/e'), the tricuspid regurgitation peak velocity, and the collapsibility of the inferior vena cava were obtained at discharge. Congestion was determined by echocardiography if any one of E/e' ≥14 (E/e' ≥11 for AF), tricuspid regurgitation peak velocity ≥2.8 m/s, or inferior vena cava collapsibility <50% was positive. We classified patients into grade A, grade B, and grade C according to the number of positive congestion indices. The primary endpoint was the composite of cardiovascular death and heart failure hospitalization.During the follow-up period (median: 373 days), 162 (32%) patients experienced the primary endpoint. Grade C patients had a higher risk for the primary endpoint than grade A (HR: 2.98; 95% CI: 1.97-4.52) and grade B patients (HR: 1.92; 95% CI: 1.29-2.86) (log-rank P < 0.0001). Echocardiographic congestion grade improved the predictive value when added to the age, sex, New York Heart Association functional class, and N-terminal pro-B-type natriuretic peptide, not only in sinus rhythm (Uno C-statistic: 0.670 vs 0.655) but in AF (Uno C-statistic: 0.667 vs 0.639).Echocardiographic congestion grade has prognostic value in patients with HFpEF with and without AF.