Abstract 14456: Left Atrial Pressure Overload in Relation to N-terminal Pro-brain Natriuretic Peptide Level on Prognosis in Patients With Heart Failure With Preserved Ejection Fraction With and Without Atrial Fibrillation

Abstract

Objective: We aimed to clarify the differences in the significance of the ratio of diastolic elastance (Ed) to arterial elastance (Ea), [Ed/Ea=(E/e’)/(0.9 х systolic blood pressure)], a relative index of left atrial (LA) pressure overload, in relation to N-terminal pro-brain natriuretic peptide (NT-proBNP) level on prognosis between patients with heart failure with preserved ejection fraction (HFpEF) with and without atrial fibrillation (AF). Methods: We studied 297 HFpEF patients hospitalized for acute decompensated heart failure (sinus rhythm/AF: 192/105). Blood testing and transthoracic echocardiography were performed before discharge. All-cause mortality was evaluated at >1 year after discharge. Results: During a median follow-up of 626 days, 47 patients (sinus rhythm/AF: 30/17) had all-cause mortality. In the subgroup with sinus rhythm, but not AF, Ed/Ea was significantly higher in patients with than without all-cause mortality. In a multivariate Cox hazard analysis, Ed/Ea was significantly associated with all-cause mortality independent of NT-proBNP in patients with sinus rhythm, but not with AF. Among patients with higher NT-proBNP levels, the effect of higher Ed/Ea on prognosis was prominent only in those with sinus rhythm (p=0.037). Conclusions: Ed/Ea provides additional prognostic information to serum NT-proBNP level for predicting all-cause mortality only in HFpEF patients with sinus rhythm. The prognostic risk factors differed between elderly HFpEF patients with and without AF.