Atrial Fibrillation, Heart Failure With Preserved Ejection Fraction (HFpEF), Intracranial Pressure, Optic Nerve Sheath Diameter, Venous Congestion
Conditions
Keywords
HFpEF;, Atrial fibrillation, Venous congestion, Optic nerve sheath diameter, Cranial MRI, Echocardiography, Intracranial pressure
Brief summary
This study was designed to investigate predictors of atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF), with a particular focus on the potential relationship between venous congestion and intracranial pressure dynamics. Among HFpEF patients, those with AF exhibited significantly higher right atrial pressure (RAP), larger right atrial area, higher CHA₂DS₂-VA scores, and increased optic nerve sheath diameter (ONSD), a noninvasive surrogate marker of intracranial pressure. In multivariable logistic regression analysis, increased ONSD, elevated RAP, larger right atrial area, and higher CHA₂DS₂-VA score remained independently associated with AF, suggesting that both systemic venous congestion and intracranial pressure-related mechanisms may contribute to AF susceptibility in this population. These findings support the hypothesis of a cardio-cerebral interaction in HFpEF, in which elevated right-sided filling pressures may impair cerebrospinal fluid drainage, increase intracranial pressure, and potentially promote AF through autonomic and hemodynamic pathways.
Detailed description
This study evaluates the association between atrial fibrillation (AF) and markers of systemic venous congestion and intracranial pressure in patients with heart failure with preserved ejection fraction (HFpEF). Using cranial MRI and echocardiographic assessment, optic nerve sheath diameter (ONSD), right atrial pressure (RAP), and atrial dimensions were analyzed as potential correlates of AF. Multivariable analysis demonstrated that increased ONSD, elevated RAP, larger right atrial area, and higher CHA₂DS₂-VA score were independently associated with AF. The findings support a potential pathophysiological link between venous congestion, intracranial pressure dynamics, and AF susceptibility in HFpEF, suggesting a possible cardio-cerebral interaction that may contribute to arrhythmogenesis and stroke risk.
Interventions
DIAGNOSTIC_TESTEchocardiography
Standard transthoracic echocardiography, including EF, E/e', TRV, atrial areas, SPAP, and estimated right atrial pressure.
Sponsors
Ankara Ataturk Sanatorium Training and Research Hospital
Study design
Observational model
CASE_CONTROL
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
60 Years to 78 Years
Healthy volunteers
Yes
Inclusion criteria
Adults aged approximately 60-78 years with available cranial MRI , HFpEF patients in sinus rhythm, HFpEF patients with atrial fibrillation No HFpEF patients(control) -
Exclusion criteria
Patients with heart failure and reduced ejection fraction (EF \<50%), known intracranial hypertension, optic nerve or other neurological disorders, chronic obstructive pulmonary disease, clinically significant goiter, liver cirrhosis, renal failure, severe valvular heart disease, congenital heart disease, and advanced diabetes mellitus requiring insulin therapy \-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Atrial fibrillation status (AF vs sinus rhythm) in HFpEF patients | Baseline | The primary analysis evaluates the association of ONSD, RAP, and the right atrial area with AF status. |
| Presence of atrial fibrillation in patients with HFpEF | At baseline (cross-sectional assessment) | The rhythm status was measured by electrocardiography and documented. The primary analysis evaluates the association of ONSD, RAP, and right atrial area with AF status. |
Countries
Turkey (Türkiye)
Contacts
STUDY_CHAIRşahbender koç, MD
AnkaraAtatürk STRH
Outcome results
None listed