The aim of this study was to evaluate the effect of upfront combination therapy with ambrisentan and tadalafil on left ventricular (LV) and right ventricular (RV) function in patients with systemic ...sclerosis-associated pulmonary arterial hypertension (SSc-PAH). LV and RV peak longitudinal and circumferential strain and strain rate (SR), which consisted of peak systolic SR (SRs), peak early diastolic SR (SRe), and peak atrial-diastolic SR (SRa) were analyzed using cardiac magnetic resonance imaging (CMRI) data from the recently published ATPAHSS-O trial (ambrisentan and tadalafil upfront combination therapy in SSc-PAH). Twenty-one patients completed the study protocol. Measures of RV systolic function (RV free wall RVFW peak longitudinal strain pLS, RVFW peak longitudinal SRs pLSRs) and RV diastolic function (RVFW peak longitudinal SRa pLSRa, RVFW peak circumferential SRe) were improved after treatment. LV systolic function (LV peak global longitudinal strain pGLS) and diastolic function (LV peak global longitudinal SRe pGLSRe) were also significantly improved at follow-up. Increased 6-min walk distance was significantly correlated with RVFW pLS and pLSRs, while the decrease in N-terminal pro-brain natriuretic peptide was correlated with LV pGLS. Increased cardiac index was associated with improved LV pGLSRe, and reduction in mean right atrial pressure was correlated with improved RVFW pLS and pLSRa. Combination therapy was associated with a significant improvement in both RV and LV function as assessed by CMR-derived strain and SR. Importantly, the improvement in RV and LV strain and SR correlated with improvements in known prognostic markers of PAH. (Approved by clinicaltrials.gov NCT01042158 before patient recruitment.)
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
BackgroundAtrial fibrillation (AF) may occur after an acute precipitant and subsequently resolve. Management guidelines for AF in these settings are unclear, since the risk of recurrent AF and ...related morbidity is poorly understood. We quantified acute precipitants of AF and compared outcomes after incident AF with and without a precipitant.MethodsFrom a multicenter electronic medical record database, we identified patients with new-onset AF between 2000-14. We developed algorithms to identify acute AF precipitants (surgery, infection, myocardial infarction, thyrotoxicosis, alcohol, pericarditis, pulmonary embolism, or other pulmonary disease). We assessed risks of AF recurrence, and its relations with heart failure, stroke, and mortality after incident AF in individuals with and without a precipitant.ResultsAmong 10,723 patients with new-onset AF, 19% had an acute AF precipitant, the most common of which were cardiac surgery (22%), pneumonia (20%) and non-cardiothoracic surgery (15%). The cumulative incidence of AF recurrence at 5 years was 41% among individuals with a precipitant compared to 52% in those without a precipitant (Figure). The lower risk of recurrence among those with precipitants was driven by postoperative AF (5-year incidence 32% in cardiac surgery and 39% in non-cardiothoracic surgery). Recurrent AF was associated with increased risks of heart failure (HR 2.74, 95% CI 2.39-3.15), stroke (HR 1.57, 95% CI 1.30-1.90), and mortality (HR 2.96, 95% CI 2.70-3.24). AF after cardiac surgery was associated with a decreased risk of heart failure (HR 0.45, 95% CI 0.28-0.71) and mortality (HR 0.70, 95% CI 0.54-0.91), but similar risk of stroke as AF without a precipitant.ConclusionsAF after an acute precipitant frequently recurs. Recurrence was associated with substantial rates of long-term morbidity. Future studies should address precipitant-specific surveillance and management after incident AF in the setting of an acute precipitant.
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