Dokument: Auswirkungen der Herzinsuffizienz mit erhaltener Auswurffraktion auf den Erfolg der Kardioversion

Titel:

Auswirkungen der Herzinsuffizienz mit erhaltener Auswurffraktion auf den Erfolg der Kardioversion

Weiterer Titel:

Impact of Heart Failure with Preserved Ejection Fraction on Cardioversion Success

URL für Lesezeichen:

https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=74942

URN (NBN):

urn:nbn:de:hbz:061-20261112-154341-8

Kollektion:

Dissertationen

Sprache:

Deutsch

Dokumententyp:

Wissenschaftliche Abschlussarbeiten » Dissertation

Medientyp:

Text

Autor:

Günther, Niklas [Autor]

Dateien:

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Dateien vom 04.11.2026 / geändert 04.11.2026

Beitragende:

PD Dr. med. Spieker, Maximilian [Gutachter]
Prof. Dr. med. Aubin, Hug [Gutachter]

Stichwörter:

Herzinsuffizienz, HFpEF, Vorhofflimmern, Kardioversion, HFpEF Scores

Dokumententyp (erweitert):

Dissertation

Dewey Dezimal-Klassifikation:

600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit

Beschreibungen:

Vorhofflimmern (VHF) ist die häufigste klinisch relevante supraventrikuläre Arrhythmie
und geht mit erhöhter Morbidität und Mortalität einher. Besonders bei Patienten mit
Herzinsuffizienz mit erhaltener Ejektionsfraktion (HFpEF) gestaltet sich das Management
schwierig, da HFpEF heterogen ist und die Evidenz für Therapieentscheidungen begrenzt
ist. Die elektrische Kardioversion (eKV) ist eine etablierte Methode zur Wiederherstellung
des Sinusrhythmus, wobei sowohl der akute Erfolg als auch das langfristige Rezidivrisiko
durch strukturelle und funktionelle kardiale Veränderungen beeinflusst werden können. Ziel
dieser Arbeit war es, die Prävalenz von HFpEF bei VHF-Patienten, die sich einer eKV
unterziehen, zu bestimmen, die strukturellen kardialen Veränderungen mittels Cardiac
Damage zu charakterisieren und deren prognostische Relevanz für Kardioversionserfolg,
Mortalität und Herzinsuffizienz-Hospitalisierung zu untersuchen.
In einer retrospektiven Analyse wurden 377 Patienten, die zwischen Januar 2016 und Juli
2024 eine ekV erhalten hatten, eingeschlossen. Daten zu Vorerkrankungen, Medikation,
Laborwerten sowie Endpunkten wie Mortalität, Herzinsuffizienz-Hospitalisierung, VHF
Rezidiv und sonstigen Interventionen wurden aus den klinikinternen Datensystemen
extrahiert. Die HFpEF-Prävalenz wurde anhand des H2FPEF- und HFA-PEFF-Scores
ermittelt, das Ausmaß struktureller kardialer Veränderungen über Cardiac Damage von 0
4 charakterisiert.
Die Ergebnisse zeigen eine hohe Prävalenz von HFpEF in dieser Kohorte: 66 % der
Patienten wiesen beim H2FPEF-Score hohe Werte (≥6 Punkte) auf, beim HFA-PEFF-Score
waren es 43,3 % (≥5 Punkte). Unter den HFpEF-Patienten zeigten 52,4 % (H2FPEF) bzw.
64,7 % (HFA-PEFF) ein fortgeschrittenes Cardiac Damage (Stadium 3–4), wobei 40,3 %
der H2FPEF-Patienten und 52,9 % der HFA-PEFF-Patienten Stadium 4 erreichten. Der
initiale Kardioversionserfolg war bei Patienten mit Early Cardiac Damage höher (91,4 %)
als bei Patienten mit Late Cardiac Damage (84,1 %, p = 0,0141), während die langfristige
Rezidivrate von atrialen Arrhythmien zwischen den Gruppen ähnlich war (kumulative
Inzidenz nach 500 Tagen: 60 %). Hohe H2FPEF-Scores korrelierten mit reduziertem
initialem Kardioversionserfolg (84,8 % vs. 93 %, p = 0,039), erhöhter Rezidivrate (50,9 %
vs. 15,9 %, p < 0,001) sowie höherer Mortalität und HI-Hospitalisierung (p = 0,0485),
während der HFA-PEFF-Score keine Zusammenhänge zeigte. Late Cardiac Damage war
ebenfalls mit erhöhter Mortalität und Herzinsuffizienz-Hospitalisierung assoziiert
(Chi² = 15,12, p < 0,001).
Die Ergebnisse unterstreichen die hohe Prävalenz von HFpEF und Late Cardiac Damage
bei VHF-Patienten vor einer ekV und zeigen, dass Late Cardiac Damage den akuten
Kardioversionserfolg negativ beeinflusst. Der H2FPEF-Score erweist sich als prädiktives
Instrument für akuten und langfristigen Kardioversionserfolg sowie für Mortalität und
Herzinsuffizienz-Hospitalisierung, während der HFA-PEFF-Score in dieser Kohorte
weniger prognostisch relevant war. Diese Erkenntnisse betonen die Bedeutung einer
differenzierten
Diagnostik,
individuellen
Risikostratifizierung
Therapieplanung bei HFpEF-Patienten vor geplanter eKV.

Atrial fibrillation (AF) is the most common clinically relevant supraventricular arrhythmia
and is associated with increased morbidity and mortality. Management is particularly
challenging in patients with HFpEF, as HFpEF is a heterogeneous condition and evidence
guiding therapeutic decisions is limited. Electrical cardioversion (eCV) is an established
method to restore sinus rhythm, with both acute success and long-term recurrence risk
influenced by structural and functional cardiac alterations. The aim of this study was to
determine the prevalence of HFpEF in AF patients undergoing eCV, to characterize
structural cardiac changes using the Cardiac Damage classification, and to assess their
prognostic relevance for cardioversion success, mortality, and heart failure hospitalization.
In this retrospective analysis, 377 patients who underwent eCV between January 2016 and
July 2024 were included. Data on comorbidities, medication, laboratory values, and
endpoints including mortality, heart failure hospitalization, AF recurrence, and other
interventions were extracted from the institution’s internal data systems. HFpEF prevalence
was assessed using the H2FPEF and HFA-PEFF scores, while the extent of structural cardiac
alterations was evaluated using the Cardiac Damage classification (stages 0–4).
The results demonstrate a high prevalence of HFpEF in this cohort: 66 % of patients had
high H2FPEF scores (≥6 points) and 43.3 % had high HFA-PEFF scores (≥5 points). Among
HFpEF patients, 52.4 % (H2FPEF) and 64.7 % (HFA-PEFF) exhibited advanced Cardiac
Damage (stages 3–4), with 40.3 % of H2FPEF patients and 52.9 % of HFA-PEFF patients
reaching stage 4. Acute cardioversion success was higher in patients with Early Cardiac
Damage (91.4 %) than in those with Late Cardiac Damage (84.1 %, p = 0.0141), while long
term recurrence of atrial arrhythmias was similar between groups (cumulative incidence at
500 days: 60 %). High H2FPEF scores were associated with reduced acute cardioversion
success (84.8 % vs. 93 %, p = 0.039), increased recurrence (50.9 % vs. 15.9 %, p < 0.001),
and higher mortality and heart failure hospitalization (p = 0.0485), whereas the HFA-PEFF
score showed no significant associations. Late Cardiac Damage was also linked to increased
mortality and heart failure hospitalization (Chi² = 15.12, p < 0.001).
These findings highlight the high prevalence of HFpEF and Late Cardiac Damage among
AF patients prior to eCV and demonstrate that Late Cardiac Damage negatively impacts
acute cardioversion success. The H2FPEF score emerged as a predictive tool for both acute
and long-term cardioversion outcomes as well as mortality and heart failure hospitalization,
whereas the HFA-PEFF score was less prognostically informative in this cohort. These
results underscore the importance of detailed diagnostics, individualized risk stratification,
and targeted therapeutic planning in HFpEF patients prior to planned eCV.

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Universitätsklinikum Düsseldorf, Deutschland (Kardioversionen vom 01.01.2016 bis zum 01.07.2024)

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Medizinische Fakultät

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Heinrich-Heine-Universität Düsseldorf

Dokument: Auswirkungen der Herzinsuffizienz mit erhaltener Auswurffraktion auf den Erfolg der Kardioversion