Pulsed and Tissue Doppler Echocardiographic Abnormalities in Patients with Diastolic Heart Failure with and without Atrial Fibrillation

Abstract

Background: Symptoms of heart failure (HF) are identical in both systolic (SHF) and diastolic hear failure (DHF). The prevalence of atrial fibrillation (AF) in heart failure varies in different studies depending on the criteria of enrollment and the use of echocardiographic parameters in the definition of HF. Aim: To assess the clinical characteristic of pa- tients with DHF complicated by AF and compare with those with SHF in regard of echocardiographic abnormalities and causative agents. Furthermore, evaluate the clinical and biochemical markers for the prediction of AF in HF. Method: Over the duration of 12 months, each patient diagnosed as HF based on admission code was enrolled in the study. Patients were classified into two groups: group 1: DHF, with preserved LVPEF% > 50%, n = 204 (60%), and group 2, with SHF, with LVREF% ≤ 50%, n = 140 (40%). The presence or absence of AF on ECG was recorded. The predictive value of different clinical and biochemical variables for the development of AF was evaluated using logistic multiple regression analysis. Results: Three hundred and forty four eligible patients were admitted to hospital with heart failure out of 7650 who had other medical problems. The prevalence of HF in this population was 4.5%, those with DHF were 2.7% and SHF of 1.8%. The incidence of AF on ECG was 35% in the whole study population and 65% were in sinus rhythm (SR). The occurrence of AF was twice higher in DHF patients of 22% compared with 11% in SHF. Echo pulsed Doppler in DHF and AF compared with those in SR showed a severe restrictive pattern with significantly thick septum wall, higher LV mass index, shorter DT and higher E/e? ratio of 12.4 vs. 9.73, P < 0.05. The predictive risk (odd ratio) of different clinical variables for development of AF in HF was positive for LV hypertrophy on ECG of 2.4, history of hypertension of 1.6, history of DM of 1.4, BMI > 28 of 1.7. Conclusions: The prevalence of HF was 4.5% in the study population, with SHF of 1.8% and DHF of 2.7%. Patients with DHF and AF were older with a higher female ratio with severe restrictive pattern compared with those of SHF. The incidence of AF in the whole study was 35%. The best predictor of AF in HF was left ventricle hypertrophy followed by history of hypertension and DM.

Share and Cite:

T. Garadah, N. Mahdi, M. Al Alwai, A. Jaradat and Z. Hasan, "Pulsed and Tissue Doppler Echocardiographic Abnormalities in Patients with Diastolic Heart Failure with and without Atrial Fibrillation," International Journal of Clinical Medicine, Vol. 3 No. 7, 2012, pp. 661-668. doi: 10.4236/ijcm.2012.37118.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] A. Mosterd, A. W. Hoes, M. C. de Bruyne, et al., “Prevalence of Heart Failure and Left Ventricular Dysfunction in the General Population; The Rotterdam Study,” European Heart Journal, Vol. 20, No. 6, 1999, pp. 447-455. doi:10.1053/euhj.1998.1239
[2] J. P. Bounhoure, P. Massabuau, M. Galinier, et al., “[Heart Failure with Preserved Left Ventricular Function: Clinical, Echocardio-graphic, and Clinical Course Features. Prognostic Factors],” Bulletin de l’Academie Nationale de Medecine, Vol. 186, No. 6, 2002, pp. 1003-1014.
[3] R. Nagarakanti and M. Ezekowitz, “Diastolic Dysfunction and Atrial Fibrillation,” Journal of Interventional Cardiac Electrophysiology, Vol. 22, No. 2, 2008, pp. 111-118. doi:10.1007/s10840-008-9203-8
[4] E. J. Benjamin, D. Levy, S. M. Vaziri, et al., “Independent Risk Factors for Atrial Fibrillation in a Population- Based Cohort. The Framingham Heart Study,” Journal of American Medical Association, Vol. 271, No. 11, 1994, pp. 840-844. doi:10.1001/jama.1994.03510350050036
[5] R. Nieuwlaat, L. W. Eurlings, J. G. Cleland, et al., “Atrial Fibrillation and Heart Failure in Cardiology Practice: Reciprocal Impact and Combined Management from the Perspective of Atrial Fibrillation: Results of the Euro Heart Survey on Atrial Fibrillation,” Journal of the American College of Cardiology, Vol. 53, No. 18, 2009, pp. 1690-1698. doi:10.1016/j.jacc.2009.01.055
[6] J. G. Cleland, K. Swedberg, F. Follath, et al., “The EuroHeart Failure Survey Programme—A Survey on the Quality of Care among Patients with Heart Failure in Europe. Part 1: Patient Characteristics and Diagnosis,” European Heart Journal, Vol. 24, No. 5, 2003, pp. 442-463. doi:10.1016/S0195-668X(02)00823-0
[7] A. J. Camm and I. Savelieva, “Atrial Fibrillation: Advances and Pers-pectives,” Dialogues in Cardiovascular Medicine, Vol. 8, 2003, pp. 183-202.
[8] M. Klapholz, M. Maurer, A. M. Lowe, et al., “Hospitalization for Heart Failure in the Presence of a Normal Left Ventricular Ejection Fraction: Results of the New York Heart Failure Registry,” Journal of the American College of Cardiology, Vol. 43, No. 8, 2004, pp. 1432-1438. doi:10.1016/j.jacc.2003.11.040
[9] S. Yusuf, M. A. Pfeffer, K. Swedberg, et al., “Effects of Candesartan in Patients with Chronic Heart Failure and Preserved Left-Ventricular Ejection Fraction: The CHARM-Preserved Trial,” Lancet, Vol. 362, No. 9386, 2003, pp. 777-781. doi:10.1016/S0140-6736(03)14285-7
[10] M. M. Redfield, G. N. Kay, L. S. Jenkins, et al., “Tachycardia-Related Cardiomyopathy: A Common Cause of Ventricular Dysfunction in Patients with Atrial Fibrillation Referred for Atrioventricular Ablation,” Mayo Clinic Proceedings, Vol. 75, No. 8, 2000, pp. 790-795. doi:10.4065/75.8.790
[11] T. S. Tsang, B. J. Gersh, C. P. Appleton, et al., “Left Ventricular Diastolic Dysfunction as a Predictor of the First Diagnosed Nonvalvular Atrial Fibrillation in 840 Elderly Men and Women,” Journal of American College of Cardiology, Vol. 40, No. 9, 2002, pp. 1636-1644. doi:10.1016/S0735-1097(02)02373-2
[12] R. S. Bhatia, J. V. Tu, D. S. Lee, et al., “Outcome of Heart Failure with Preserved Ejection Fraction in a Population-Based Study,” New England Journal of Medicine, Vol. 355, No. 3, 2006, pp. 260-269. doi:10.1056/NEJMoa051530
[13] T. Fujino, T. Yamashita, S. Suzuki, et al., “Characteristics of Congestive Heart Failure Accompanied by Atrial Fibrillation with Special Reference to Tachycardia-Induced Cardiomyopathy,” Circulation Journal, Vol. 71, No. 6, 2007, pp. 936-940. doi:10.1253/circj.71.936
[14] K. Dickstein, “Natriuretic Peptides in Detection of Heart Failure,” Lancet, Vol. 351, No. 9095, 1998, pp. 9-13. doi:10.1016/S0140-6736(05)78100-9
[15] A. S. Maisel, P. Krishnaswamy, R. M. Nowak, et al., “Rapid Mea-surement of B-Type Natriuretic Peptide in the Emergency Diagnosis of Heart Failure,” New England Journal of Medicine, Vol. 347, No. 3, 2002, pp. 161-167. doi:10.1056/NEJMoa020233
[16] K. Dickstein, A. Co-hen-Solal, G. Filippatos, et al., “ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in Col-laboration with the Heart Failure Association of the ESC (HFA) and Endorsed by the European Society of Intensive Care Medicine (ESICM),” European Journal of Heart Failure, Vol. 10, No. 10, 2008, pp. 933-989. doi:10.1016/j.ejheart.2008.08.005
[17] P. Verdecchia, G. Schillaci, C. Borgioni, et al., “Prognostic Value of a New Electrocardiographic Method for Diagnosis of Left Ventricular Hypertrophy in Essential Hypertension,” Journal of the American College of Cardiology, Vol. 31, No. 2, 1998, pp. 383-390. doi:10.1016/S0735-1097(97)00493-2
[18] A. S. Go, E. M. Hylek, K. A. Phillips, et al., “Prevalence of Diagnosed Atrial Fibrillation in Adults: National Implications for Rhythm Management and Stroke Prevention: The AnTi-coagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study,” Journal of the American Medical Association, Vol. 285, No. 18, 2001, pp. 2370-2375. doi:10.1001/jama.285.18.2370
[19] D. J. Sahn, A. De-Maria, J. Kisslo, et al., “Recommendations Regarding Quantitation in M-Mode Echocardiography: Results of a Survey of Echocardiographic Measure- ments,” Circulation, Vol. 58, No. 6, 1978, pp. 1072-1083. doi:10.1161/01.CIR.58.6.1072
[20] J. G. F. Cleland, E. Erdmann, R. Ferrari, et al., “Guidelines for the Diagnosis of Heart Failure,” European Heart Journal, Vol. 16, 1995, p. 741.
[21] R. M. Lang, M. Bierig, R. B. Devereux, et al., “Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology,” Journal of the American Society of Echocardiography, Vol. 18, No. 12, 2005, pp. 1440-1463. doi:10.1016/j.echo.2005.10.005
[22] S. F. Nagueh, C. P. Appleton, T. C. Gillebert, et al., “Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography,” European Journal of Echocardio-graphy, Vol. 10, No. 2, 2009, pp. 165-193. doi:10.1093/ejechocard/jep007
[23] M. J. Koren, R. B. Devereux, P. N. Casale, et al., “Relation of Left Ventri-cular Mass and Geometry to Morbidity and Mortality in Uncomplicated Essential Hypertension,” Annals of Internal Medicine, Vol. 114, No. 5, 1991, pp. 345-352.
[24] F. Ceia, C. Fonseca, T. Mota, et al., “Prevalence of Chronic Heart Failure in Southwestern Europe: The EPICA Study,” European Journal of Heart Failure, Vol. 4, No. 4, 2002, pp. 531-539. doi:10.1016/S1388-9842(02)00034-X
[25] B. M. Massie and N. B. Shah, “Evolving Trends in the Epidemiologic Factors of Heart Failure: Rationale for Preventive Strategies and Comprehensive Disease Management,” American Heart Journal, Vol. 133, No. 6, 1997, pp. 703-712. doi:10.1016/S0002-8703(97)70173-X
[26] G. F. Mureddu, N. Agabiti, V. Rizzello, et al., “Prevalence of Preclinical and Clinical Heart Failure in the Elderly. A Population-Based Study in Central Italy,” European Journal of Heart Fail, Vol. 14, No. 7, 2012, pp. 718-729. doi:10.1093/eurjhf/hfs052
[27] J. G. Cleland, A. Khand and A. Clark, “The Heart Failure Epidemic: Exactly How Big Is It?” European Heart Journal, Vol. 22, No. 8, 2001, pp. 623-626. doi:10.1053/euhj.2000.2493
[28] J. Grewal, R. S. McKelvie, H. Persson, et al., “Usefulness of N-Terminal Pro-Brain Natriuretic Peptide and Brain Natriuretic Peptide to Predict Cardiovascular Outcomes in Patients with Heart Failure and Preserved Left Ventricu- lar Ejection Fraction,” American Journal of Cardiology, Vol. 102, No. 6, 2008, pp. 733-737. doi:10.1016/j.amjcard.2008.04.048
[29] S. J. Phillips, J. P. Whisnant, W. M. O’Fallon, et al., “Prevalence of Cardiovascular Disease and Diabetes Mellitus in Residents of Rochester, Minnesota,” Mayo Clinic Proceedings, Vol. 65, No. 3, 1990, pp. 344-359. doi:10.1016/S0025-6196(12)62535-X
[30] T. A. McDo-nagh, C. E. Morrison, A. Lawrence, et al., “Symptomatic and Asymptomatic Left-Ventricular Sys- tolic Dysfunction in an Urban Population,” Lancet, Vol. 350, No. 9081, 1997, pp. 829-833. doi:10.1016/S0140-6736(97)03033-X
[31] J. E. Moller, E. Sondergaard, S. H. Poulsen, et al., “Pseudonormal and Restrictive Filling Patterns Predict Left Ventricular Dilation and Cardiac Death after a First Myocardial Infarction: A Serial Color M-Mode Doppler Echocardiographic Study,” Journal of the American College of Cardiology, Vol. 36, No. 6, 2000, pp. 1841-1846. doi:10.1016/S0735-1097(00)00965-7
[32] F. Bursi, S. A. Weston, M. M. Redfield, et al., “Systolic and Diastolic Heart Failure in the Community,” Journal of American Medical Association, Vol. 296, No. 18, 2006, pp. 2209-2216. doi:10.1001/jama.296.18.2209
[33] N. Ilksoy, M. Hoffman, R. H. Moore, et al., “Comparison of African-American Patients with Systolic Heart Failure versus Preserved Ejection Fraction,” American Journal of Cardiology, Vol. 98, No. 6, 2006, pp. 806-808. doi:10.1016/j.amjcard.2006.03.066
[34] E. P. Havranek, F. A. Masoudi, K. A. Westfall, et al., “Spectrum of Heart Failure in Older Patients: Results from the National Heart Failure Project,” American Heart Journal, Vol. 143, No. 3, 2002, pp. 412-417. doi:10.1067/mhj.2002.120773
[35] J. I. Haft and L. E. Teichholz, “Echocardiographic and Clinical Risk Factors for Atrial Fibrillation in Hypertensive Patients with Ischemic Stroke,” American Journal of Cardiology, Vol. 102, No. 10, 2008, pp. 1348-1351. doi:10.1016/j.amjcard.2008.07.009
[36] F. L. Dini, U. Conti, P. Fontanive, et al., “Prognostic Value of N-Terminal Pro-Type-B Natriuretic Peptide and Doppler Left Ventricular Diastolic Variables in Patients with Chronic Systolic Heart Failure Stabilized by Therapy,” American Journal of Cardiology, Vol. 102, No. 4, 2008, pp. 463-468. doi:10.1016/j.amjcard.2008.03.083
[37] B. Al-Aloul, J. M. Li, D. Benditt, et al., “Atrial Fibrillation Associated with Hypokalemia Due to Primary Hyperal-dosteronism (Conn’s Syndrome),” Pacing and Clini- cal Electrophysiology, Vol. 29, No. 11, 2006, pp. 1303-1305. doi:10.1111/j.1540-8159.2006.00536.x
[38] E. J. Topol, T. A. Traill and N. J. Fortuin, “Hypertensive Hypertrophic Cardiomyopathy of the Elderly,” New England Journal of Medicine, Vol. 312, No. 5, 1985, pp. 277-283. doi:10.1056/NEJM198501313120504
[39] M. A. Allessie, P. A. Boyden, A. J. Camm, et al., “Pathophysiology and Prevention of Atrial Fibrillation,” Circulation, Vol. 103, No. 5, 2001, pp. 769-777. doi:10.1161/01.CIR.103.5.769
[40] J. S. Shinbane, M. A. Wood, D. N. Jensen, et al., “Tachycardia-Induced Cardiomyopathy: A Review of Animal Models and Clinical Studies,” Journal of the American College of Cardiology, Vol. 29, No. 4, 1997, pp. 709-715. doi:10.1016/S0735-1097(96)00592-X

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.