title: Outcome prediction in heart failure with atrial fibrillation: relative role of left ventricular ejection fraction and neurohormonal measures.
abstract: BACKGROUND
  Since atrial fibrillation (AF) impacts the measurement and interpretation of left ventricular ejection fraction (LVEF), we hypothesized that the outcome in heart failure (HF) with AF and LVEF ≤ 35% would be more strongly associated with neurohormonal measures than LVEF.
  
  
  RESULTS
  Cardiac adverse events [CAE; HF progression (HFP), life-threatening arrhythmia (ARR), and cardiac death (CD)] and all-cause mortality (ACM) were recorded prospectively in 954 patients with HF and LVEF ≤ 35%: 852 in sinus rhythm (SR) and 102 in AF. Cox proportional hazard models found that the univariate hazard ratios (HR) for LVEF and the first CAE (primary outcome), HFP, ARR, CD, and ACM were significant in SR (0.933, P < .001, 0.933, P < .001, 0.929, P < .001, 0.916, P < .001, 0.945, P = .001, respectively), but not in AF (1.002, P = .95, 1.060, P = .24, 0.922, P = .15, 0.885, P = .09, 0.932, P = .25). HRs for CAEs and ACM and one or more neurohormonal measures (iodine 123 m-iodobenzylguanidine cardiac parameters, B-type natriuretic peptide, and plasma norepinephrine) were significant in SR and AF. The multivariate models for the first CAE and HFP included neurohormonal measures and LVEF in SR and neurohormonal measures in AF.
  
  
  CONCLUSIONS
  In HF with LVEF ≤ 35% with AF, neurohormonal measures, but not LVEF, were related to outcomes.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA, clements.ian@mayo.edu.
authors.forename: Ian P
authors.initials: IP
authors.lastname: Clements
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Wiseman
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: Arnold F
authors.initials: AF
authors.lastname: Jacobson
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000175:diagnosis; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications* / Q000628:therapy; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000628:therapy; D006728:Hormones / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009638:Norepinephrine / Q000097:blood; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D006728:Hormones; D020097:Natriuretic Peptide, Brain; D019797:3-Iodobenzylguanidine; D009638:Norepinephrine