Sex Differences In Presentation And Outcomes Of Cardiac Sarcoidosis
HFSA ePoster Library. Duvall C. 09/10/21; 343611; 55
Chloe Duvall
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Abstract
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Introduction: Patients with symptomatic heart failure (HF) have an increased incidence of atrial tachycardia/fibrillation (AT/AF). However, the relationship of mean pulmonary artery pressure (mPAP) as a marker for decompensation to AT/AF is unknown. Similarly, whether successful treatment of elevated mPAP reduces AT/AF is unknown.
Methods: Patients with an implantable CIEDS in the Cardiomems™ Post-Approval Study (PAS Study) were analyzed for AT/AF burden (episodes of total duration >30 s per day) and incidence of symptomatic AT/AF. The change in mPAP was also evaluated prior to AT/AF episodes.
Results: Of the 1189 patients in the PAS study, with baseline mPAP > 10 mmHg, 387 (32.6%) with CIEDS were evaluated. Patients with AT/AF (n = 93) were stratified by baseline mPAP: Group 1: <25mmHg, Group 2: 25-35mmHg, and Group 3: >35mmHg. The mean age was 68 years and 18.3% female. 79.6% had a history of AT/AF and patients with elevated baseline mPAP were much more likely to have history of arrhythmia (54.2%, 90.2% and 85.7% for Groups 1,2 and 3 respectively; p=0.002). However, there was no significant difference in freedom from symptomatic AT/AF over the study f/u of 24 months (figure). Device data revealed 3.5% of total follow-up days with AT/AF, with fewer days in Group 1 versus Groups 2 and 3 (2.0% versus 4.1% and 4.0%; p<0.0001). During the trial period, 49% of AT/AF episodes were associated with an increase in mPAP relative to baseline and was seen more commonly in patients with lower baseline mPAP (75%, 46% and 32% for Groups 1, 2 and 3 respectfully; p=0.008). Change in mPAP relative to baseline, in the 2 weeks prior to an episode, was highest in group1 (area under the curve - median(Q1, Q3) mmHg*days: Group 1: 38.0 (-1.5, 96.0); Group 2: -5.0(-56.5,40.0); Group 3: -29(-98,14)).
Conclusions: Despite having a higher incidence of AT/AF at baseline, there was no difference in symptomatic arrhythmia during the PAS study f/u in patients with a CIEDS. Increases in mPAP were associated with 49% of AT/AF episodes, more common in patients with baseline lower mPAP. This supports the notion that chronic management of ambulatory mPAP is associated with reduction in AT/AF and abrupt increases may be associated with acute episodes.
Methods: Patients with an implantable CIEDS in the Cardiomems™ Post-Approval Study (PAS Study) were analyzed for AT/AF burden (episodes of total duration >30 s per day) and incidence of symptomatic AT/AF. The change in mPAP was also evaluated prior to AT/AF episodes.
Results: Of the 1189 patients in the PAS study, with baseline mPAP > 10 mmHg, 387 (32.6%) with CIEDS were evaluated. Patients with AT/AF (n = 93) were stratified by baseline mPAP: Group 1: <25mmHg, Group 2: 25-35mmHg, and Group 3: >35mmHg. The mean age was 68 years and 18.3% female. 79.6% had a history of AT/AF and patients with elevated baseline mPAP were much more likely to have history of arrhythmia (54.2%, 90.2% and 85.7% for Groups 1,2 and 3 respectively; p=0.002). However, there was no significant difference in freedom from symptomatic AT/AF over the study f/u of 24 months (figure). Device data revealed 3.5% of total follow-up days with AT/AF, with fewer days in Group 1 versus Groups 2 and 3 (2.0% versus 4.1% and 4.0%; p<0.0001). During the trial period, 49% of AT/AF episodes were associated with an increase in mPAP relative to baseline and was seen more commonly in patients with lower baseline mPAP (75%, 46% and 32% for Groups 1, 2 and 3 respectfully; p=0.008). Change in mPAP relative to baseline, in the 2 weeks prior to an episode, was highest in group1 (area under the curve - median(Q1, Q3) mmHg*days: Group 1: 38.0 (-1.5, 96.0); Group 2: -5.0(-56.5,40.0); Group 3: -29(-98,14)).
Conclusions: Despite having a higher incidence of AT/AF at baseline, there was no difference in symptomatic arrhythmia during the PAS study f/u in patients with a CIEDS. Increases in mPAP were associated with 49% of AT/AF episodes, more common in patients with baseline lower mPAP. This supports the notion that chronic management of ambulatory mPAP is associated with reduction in AT/AF and abrupt increases may be associated with acute episodes.
Introduction: Patients with symptomatic heart failure (HF) have an increased incidence of atrial tachycardia/fibrillation (AT/AF). However, the relationship of mean pulmonary artery pressure (mPAP) as a marker for decompensation to AT/AF is unknown. Similarly, whether successful treatment of elevated mPAP reduces AT/AF is unknown.
Methods: Patients with an implantable CIEDS in the Cardiomems™ Post-Approval Study (PAS Study) were analyzed for AT/AF burden (episodes of total duration >30 s per day) and incidence of symptomatic AT/AF. The change in mPAP was also evaluated prior to AT/AF episodes.
Results: Of the 1189 patients in the PAS study, with baseline mPAP > 10 mmHg, 387 (32.6%) with CIEDS were evaluated. Patients with AT/AF (n = 93) were stratified by baseline mPAP: Group 1: <25mmHg, Group 2: 25-35mmHg, and Group 3: >35mmHg. The mean age was 68 years and 18.3% female. 79.6% had a history of AT/AF and patients with elevated baseline mPAP were much more likely to have history of arrhythmia (54.2%, 90.2% and 85.7% for Groups 1,2 and 3 respectively; p=0.002). However, there was no significant difference in freedom from symptomatic AT/AF over the study f/u of 24 months (figure). Device data revealed 3.5% of total follow-up days with AT/AF, with fewer days in Group 1 versus Groups 2 and 3 (2.0% versus 4.1% and 4.0%; p<0.0001). During the trial period, 49% of AT/AF episodes were associated with an increase in mPAP relative to baseline and was seen more commonly in patients with lower baseline mPAP (75%, 46% and 32% for Groups 1, 2 and 3 respectfully; p=0.008). Change in mPAP relative to baseline, in the 2 weeks prior to an episode, was highest in group1 (area under the curve - median(Q1, Q3) mmHg*days: Group 1: 38.0 (-1.5, 96.0); Group 2: -5.0(-56.5,40.0); Group 3: -29(-98,14)).
Conclusions: Despite having a higher incidence of AT/AF at baseline, there was no difference in symptomatic arrhythmia during the PAS study f/u in patients with a CIEDS. Increases in mPAP were associated with 49% of AT/AF episodes, more common in patients with baseline lower mPAP. This supports the notion that chronic management of ambulatory mPAP is associated with reduction in AT/AF and abrupt increases may be associated with acute episodes.
Methods: Patients with an implantable CIEDS in the Cardiomems™ Post-Approval Study (PAS Study) were analyzed for AT/AF burden (episodes of total duration >30 s per day) and incidence of symptomatic AT/AF. The change in mPAP was also evaluated prior to AT/AF episodes.
Results: Of the 1189 patients in the PAS study, with baseline mPAP > 10 mmHg, 387 (32.6%) with CIEDS were evaluated. Patients with AT/AF (n = 93) were stratified by baseline mPAP: Group 1: <25mmHg, Group 2: 25-35mmHg, and Group 3: >35mmHg. The mean age was 68 years and 18.3% female. 79.6% had a history of AT/AF and patients with elevated baseline mPAP were much more likely to have history of arrhythmia (54.2%, 90.2% and 85.7% for Groups 1,2 and 3 respectively; p=0.002). However, there was no significant difference in freedom from symptomatic AT/AF over the study f/u of 24 months (figure). Device data revealed 3.5% of total follow-up days with AT/AF, with fewer days in Group 1 versus Groups 2 and 3 (2.0% versus 4.1% and 4.0%; p<0.0001). During the trial period, 49% of AT/AF episodes were associated with an increase in mPAP relative to baseline and was seen more commonly in patients with lower baseline mPAP (75%, 46% and 32% for Groups 1, 2 and 3 respectfully; p=0.008). Change in mPAP relative to baseline, in the 2 weeks prior to an episode, was highest in group1 (area under the curve - median(Q1, Q3) mmHg*days: Group 1: 38.0 (-1.5, 96.0); Group 2: -5.0(-56.5,40.0); Group 3: -29(-98,14)).
Conclusions: Despite having a higher incidence of AT/AF at baseline, there was no difference in symptomatic arrhythmia during the PAS study f/u in patients with a CIEDS. Increases in mPAP were associated with 49% of AT/AF episodes, more common in patients with baseline lower mPAP. This supports the notion that chronic management of ambulatory mPAP is associated with reduction in AT/AF and abrupt increases may be associated with acute episodes.
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