Digoxin improves systolic cardiac function in patients with AF and HFpEF: the RATE-AF randomised trial

Abstract Background The RAte control Therapy Evaluation in permanent AF trial (RATE-AF; NCT02391337) was the first head-to-head controlled of beta-blockers versus digoxin patients with atrial fibrillation (AF) and symptoms heart failure. Patients randomised to had similar physical-related quality life rate, significantly improved functional class, reduced N-terminal pro-brain natriuretic peptide (NT-proBNP) substantially less adverse events. impact rate therapy on measures cardiac function is not currently understood. Purpose To compare effect systolic diastolic according failure sub-type. Methods Blinded echocardiograms assessing were performed at baseline 12 month follow-up, using a robust method account for rhythm irregularity (average three index-beats acquired appropriate cycles). Outcomes change left-ventricular ejection fraction (LVEF), tissue Doppler velocity (s'), stroke volume, global longitudinal strain (GLS), (e'), mitral E wave deceleration time, E/e', pulmonary vein isovolumic relaxation time left fraction. Analyses stratified by LVEF (≥50%, 40–50% <40%). Results 160 randomised, which 145 survived 12-month follow-up median age 75 years (IQR 69–82) 44% women. Median 96 beats/min 86–112), blood pressure 135/85 mmHg 124/77–146/91), NTproBNP 1049 pg/mL (744–1463) mean NYHA class 2.4 (SD 0.6). In 119 ≥50% baseline, parameters over therapy. There greater improvement 63 compared 67 beta-blockers; Figure 1. higher (adjusted difference [AMD] 2.3%, 95% CI 0.3–4.2; p=0.021), s' (1.1cm/s, 1.0–1.2; p=0.003) volume (6.5mL, 0.4–12.6; p=0.037) beta-blockers, without any (Figure 2). 16 increased (AMD 1.5 cm/s, 1.2–1.7; p=0.001), no other or parameters. 10 <40% showed between echocardiographic measures. Conclusion AF, preserved have multiple conventional treatment beta-blockers. Funding Acknowledgement Type funding sources: Public Institution(s). Main source(s): National Institute Health Research