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

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

doi:10.1016/j.jacasi.2021.10.012

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

JACC Asia. 2022 Jan 18;2(1):73-84. doi: 10.1016/j.jacasi.2021.10.012. eCollection 2022 Feb.

Authors

Haruhiko Abe¹, Shumpei Kosugi¹, Tatsuhisa Ozaki¹, Tsuyoshi Mishima¹, Motoo Date¹, Yasunori Ueda¹, Masaaki Uematsu¹, Shunsuke Tamaki², Masamichi Yano³, Takaharu Hayashi⁴, Akito Nakagawa^{5

6}, Yusuke Nakagawa⁷, Takahisa Yamada², Yoshio Yasumura⁵, Tomoharu Dohi⁸, Shinichiro Suna⁸, Shungo Hikoso⁸, Daisaku Nakatani⁸, Yukihiro Koretsune¹, Yasushi Sakata⁸

Affiliations

¹ Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan.
² Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
³ Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan.
⁴ Division of Cardiology, Osaka Police Hospital, Osaka, Japan.
⁵ Division of Cardiology, Amagasaki Chuo Hospital, Amagasaki, Japan.
⁶ Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan.
⁷ Division of Cardiology, Kawanishi City Hospital, Kawanishi, Japan.
⁸ Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.

Abstract

Background: Atrial fibrillation (AF) is common in heart failure with preserved ejection fraction (HFpEF).

Objectives: 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.

Methods: 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.

Results: 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).

Conclusions: Echocardiographic congestion grade has prognostic value in patients with HFpEF with and without AF.

Keywords: AF, atrial fibrillation; ASE, American Society of Echocardiography; E/e′, ratio of early diastolic transmitral flow velocity to mitral annulus velocity; EACVI, European Association of Cardiovascular Imaging; HFpEF, heart failure with preserved ejection fraction; IVC, inferior vena cava; IVCC, inferior vena cava collapsibility; NT-proBNP, N-terminal pro–B-type natriuretic peptide; NYHA, New York Heart Association; TRV, tricuspid regurgitation peak velocity; congestion; echocardiography; heart failure with preserved ejection fraction; prognosis.