Heart failure & cardiomyopathiesResearch article
CMR Detected Atrial Structural and Functional Remodeling in Atrial Fibrillation (AF) Heart Failure with Reduced Ejection Fraction (HFrEF)
- multicenter studies
Authors' conclusion
Sinus rhythm restoration with CA, along with reduction in biatrial size, led to increases in biatrial EF compared with MRC. AF burden, over the binary endpoint of rhythm at follow-up, better predicted changes in LAEF, functional status, and LVEF. LAEF predicts improvements in LVEF over the endpoint of sinus rhythm at follow-up, suggesting that restoration of atrial contractile function is a key feature of recovery in HFrEF.
Study context
- Population
- AF HFrEF patients from the CAMERA-MRI and CAMERA-MRI II multicenter studies17 women, age 60.7 ± 11.1 years
- Participants
- 123 patients
- Comparison
- comparing catheter ablation (CA) to medical rate control (MRC)
- CAn = 82
- MRCn = 41
Main finding
As reported in the abstract
CA patients had reverse remodeling of all structural and functional biatrial parameters
P < 0.001
Further findings
6MWT improved
- 6MWT improved: P = 0.002
Independent associations with Δ LVEF (multivariable)
- Δ left atrial emptying fraction (LAEF)
- 95% CI: 0.23-0.54; P < 0.001
- AF burden
- 95% CI: −0.16 to −0.01; P = 0.020
- sinus rhythm at follow-up was no longer significant
- P = 0.865
Univariable predictors of Δ6MWT
- ΔLAEF
- R = 0.27; 95% CI: 0.52-2.47; P = 0.003
- ΔLVEF
- R = 0.23; 95% CI: 0.33-2.52; P = 0.011
- AF burden
- R = 0.27; 95% CI: −1.15 to −0.19; P = 0.007
- none remained significant on multivariable analysis
Original publication
Summarised from the published abstract; every number is checked against it