Abstract
Introduction: In patients have heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF), anticoagulation therapy to prevent thromboembolic events was essential but occurs often bleeding complication. We explored echocardiographic markers to predict clinical outcome. Method: In-hospitalized 282 patients with HFrEF and AF between 2000 and 2021 were retrospectively analyzed. The presence of inferior vena cava plethora (IVCP) was confirmed by echocardiography at the time of admission. Eighty-five patients who had IVCP (IVCP group) was compared to 197 patients (70%) who did not have IVCP (control group) Result: IVCP group had more CKD (24% vs 13%, p=0.036), lower platelet (171k±63 vs 192k±64, p=0.007) and lower left ventricular ejection fraction (30±9 vs 34±11 p=0.001) than control group. Major bleeding event during 5 years follow up occurs significantly higher in IVCP group (Kaplan Meier Method, Log rank p=0.042) (figure). Gastrointestinal (GI) bleeding was 73% of major bleeding. In multivariable analysis, the IVCP was independent predictor of major bleeding (HR, 2.17; 95% CI 1.06-4.44). Conclusion: In patients with HFrEF and AF requiring antithrombotic treatment, IVCP was a predictor of major bleeding, especailly GI bleeding.
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