Relationship Between Degree of LV Dysfunction, Symptom Status, and Risk of Embolic Events in AF and HF | Journal Scan

Study Questions:

What is the relationship between degree of left ventricular (LV) dysfunction and severity of heart failure (HF) with the risk of stroke in patients with nonvalvular atrial fibrillation (AF)?


Patients with a history of AF and HF who participated in the ACTIVE A (clopidogrel vs. aspirin) and ACTIVE W (clopidogrel + aspirin vs. warfarin) trials were included in the study. Only patients who were randomized to antiplatelet therapy (n = 3,487) were included in the study. HF was categorized as preserved (ejection fraction ≥50%) or reduced (EF <50%) (HF-PEF vs. HF-REF). Assessment of EF was available in 2,072 patients (59%).


Multivariable analysis revealed age ≥75 years, prior thromboembolic event, and female gender as independent predictors of stroke. Neither reduced EF nor HF severity was associated with stroke. There was no difference in the risk of stroke in patients with HF-PEF and HF-REF.


In patients with AF and HF who were taking antiplatelet therapy, the risk of stroke appears to be independent of degree of LV dysfunction and severity of functional limitation.


The CHA2DS2VASc risk stratification scheme includes HF as one of the variables that has been shown to be associated with an increased risk of thromboembolic events in patients with AF. The results of this study should not alter this practice. Note that all patients in the study had HF and hence, its purpose was not to determine whether HF is a risk, for which patients without HF must be included. The take-home message is that the etiology of HF (systolic vs. diastolic) or degree of functional limitation was not associated with stroke in the study population.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Atrial Fibrillation, Heart Failure, Stroke, Ventricular Dysfunction, Left, Thromboembolism, Risk

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