title: Clinical and prognostic effects of atrial fibrillation in heart failure patients with reduced and preserved left ventricular ejection fraction.
abstract: OBJECTIVE
  Atrial fibrillation (AF) is common in heart failure (HF), but few data regarding the prognostic relevance of AF are available in HF patients with preserved left ventricular ejection fraction (HF-PEF). We aimed to study the clinical impact of AF vs. sinus rhythm (SR) in stabilized HF patients with reduced left ventricular ejection fraction (HF-REF) and in those with preserved left ventricular ejection fraction (HF-PEF).
  
  
  RESULTS
  We studied 927 patients with stable HF, of whom 336 (36%) had AF. N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations were measured at baseline and patients were followed for 18 months. We compared time to first HF (re-)hospitalization or death between patients with AF and SR. Atrial fibrillation was present at baseline in 215 (35%) patients with HF-REF (mean LVEF 0.25 + 0.08) and in 121 (40%) patients with HF-PEF (mean LVEF 0.50 + 0.09). Plasma NT-proBNP levels were similar in AF and SR patients (median 2398 vs. 2532 pg/mL, P = 0.74). Atrial fibrillation was independently associated with elevated NT-proBNP levels in HF-PEF, but not in HF-REF patients (multivariable B = 0.33, P= 0.047 and B = 0.03; P = 0.89, respectively). After 18 months of follow-up, the presence of AF was an independent predictor of death or HF hospitalization in HF-PEF (multivariable hazard ratio 1.49 (95% CI 1.04-2.14), P = 0.03), but not in HF-REF patients (1.05 (CI 95% 0.80-1.38), P = 0.72).
  
  
  CONCLUSIONS
  Atrial fibrillation is equally common in patients with HF-PEF and HF-REF. In HF-PEF, but not in HF-REF patients, AF was associated with higher NT-proBNP levels and was independently related to death or HF hospitalization.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen. g.c.m.linssen@thorax.umcg.nl
authors.forename: Gerard C M
authors.initials: GC
authors.lastname: Linssen
authors.forename: Michiel
authors.initials: M
authors.lastname: Rienstra
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: van Gelder
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009426:Netherlands; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume
chemical_list: D020097:Natriuretic Peptide, Brain