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Open Access 01-12-2024 | Research

Is atrial fibrillation in HFpEF a distinct phenotype? Insights from multiparametric MRI and circulating biomarkers

Authors: Abhishek Dattani, Emer M. Brady, Prathap Kanagala, Svetlana Stoma, Kelly S. Parke, Anna-Marie Marsh, Anvesha Singh, Jayanth R. Arnold, Alastair J. Moss, Lei Zhao, Mary Ellen Cvijic, Matthew Fronheiser, Shuyan Du, Philippe Costet, Peter Schafer, Leon Carayannopoulos, Ching-Pin Chang, David Gordon, Francisco Ramirez-Valle, Michael Jerosch-Herold, Christopher P. Nelson, Iain B. Squire, Leong L. Ng, Gaurav S. Gulsin, Gerry P. McCann

Published in: BMC Cardiovascular Disorders | Issue 1/2024

Abstract

Background

Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) frequently co-exist. There is a limited understanding on whether this coexistence is associated with distinct alterations in myocardial remodelling and mechanics. We aimed to determine if patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) represent a distinct phenotype.

Methods

In this secondary analysis of adults with HFpEF (NCT03050593), participants were comprehensively phenotyped with stress cardiac MRI, echocardiography and plasma fibroinflammatory biomarkers, and were followed for the composite endpoint (HF hospitalisation or death) at a median of 8.5 years. Those with AF were compared to sinus rhythm (SR) and unsupervised cluster analysis was performed to explore possible phenotypes.

Results

136 subjects were included (SR = 75, AF = 61). The AF group was older (76 ± 8 vs. 70 ± 10 years) with less diabetes (36% vs. 61%) compared to the SR group and had higher left atrial (LA) volumes (61 ± 30 vs. 39 ± 15 mL/m², p < 0.001), lower LA ejection fraction (EF) (31 ± 15 vs. 51 ± 12%, p < 0.001), worse left ventricular (LV) systolic function (LVEF 63 ± 8 vs. 68 ± 8%, p = 0.002; global longitudinal strain 13.6 ± 2.9 vs. 14.7 ± 2.4%, p = 0.003) but higher LV peak early diastolic strain rates (0.73 ± 0.28 vs. 0.53 ± 0.17 1/s, p < 0.001). The AF group had higher levels of syndecan-1, matrix metalloproteinase-2, proBNP, angiopoietin-2 and pentraxin-3, but lower level of interleukin-8. No difference in clinical outcomes was observed between the groups. Three distinct clusters were identified with the poorest outcomes (Log-rank p = 0.029) in cluster 2 (hypertensive and fibroinflammatory) which had equal representation of SR and AF.

Conclusions

Presence of AF in HFpEF is associated with cardiac structural and functional changes together with altered expression of several fibro-inflammatory biomarkers. Distinct phenotypes exist in HFpEF which may have differing clinical outcomes.

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Title: Is atrial fibrillation in HFpEF a distinct phenotype? Insights from multiparametric MRI and circulating biomarkers
Authors: Abhishek Dattani
Emer M. Brady
Prathap Kanagala
Svetlana Stoma
Kelly S. Parke
Anna-Marie Marsh
Anvesha Singh
Jayanth R. Arnold
Alastair J. Moss
Lei Zhao
Mary Ellen Cvijic
Matthew Fronheiser
Shuyan Du
Philippe Costet
Peter Schafer
Leon Carayannopoulos
Ching-Pin Chang
David Gordon
Francisco Ramirez-Valle
Michael Jerosch-Herold
Christopher P. Nelson
Iain B. Squire
Leong L. Ng
Gaurav S. Gulsin
Gerry P. McCann
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Cardiovascular Disorders / Issue 1/2024
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/s12872-024-03734-0

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Is atrial fibrillation in HFpEF a distinct phenotype? Insights from multiparametric MRI and circulating biomarkers

Abstract

Background

Methods

Results

Conclusions

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Abstract

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