P377A new tissue Doppler parameter in predicting future development of atrial fibrillation in patients with left ventricular dysfunction

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Onset of atrial fibrillation (AF) in patients with left ventricular (LV) dysfunction is usually associated with a high occurrence of cardiovascular complications. E/(E'×S') ratio (E = peak early diastolic transmitral velocity, E' = peak early mitral annular diastolic velocity and S'= peak systolic mitral annulus velocity) has been shown to reflect LV filling pressure.Objectives: We investigate whether E/(E'×S') could be a predictor of new-onset AF in patients with LV dysfunction.Methods: We analyzed 113 consecutive hospitalized patients with LV dysfunction, in sinus rhythm, after appropriate medical treatment. Patients with histories of AF, inadequate echocardiographic images, congenital heart disease, paced rhythm, significant primary valvular disease, acute coronary syndrome, coronary revascularization during follow-up, severe pulmonary disease or renal failure were not included. E/(E'×S') was determined using the average of septal and lateral mitral annular velocities. The primary study end-point was the new-onset AF.Results: During the follow-up period (35.7±11.2 months), 33 patients (29.2%) developed AF. Mean E/(E'×S') was 3.09±1.12 in these patients, while it was 1.72±1.34 in the rest (p<0.001). The optimal E/(E'×S') cut-off to predict new-onset AF was 2.2 (88% sensitivity, 77% specificity). There were 64 patients (56.6%) with E/(E'×S')≤2.2 and 49 (43.4%) with E/(E'×S')>2.2. The AF onset was significantly higher in the group with E/(E'×S')>2.2 than in the group with E/(E'×S')≤2.2 [29 (59.1%) versus 4 (6.2%), p<0.001]. Kaplan–Meier analysis showed that the event-free survival rate during follow-up was significantly higher in the group of patients with E/(E'×S')≤2.2 (log rank, p<0.001). On multivariate Cox analysis including the variables that predicted AF on univariate analysis [N-terminal pro-brain natriuretic peptide levels, severe mitral regurgitation, LV ejection fraction, left atrial volume, left atrial volume index, E/A (A = peak late diastolic transmitral flow), S', E', E/E' ratio, E/(E'×S'), LV ejection fraction≤40% combined with E/E' >15, and restrictive pattern], the E/(E'×S') index was the only independent predictor of new-onset AF (hazard ratio = 2.26, 95% confidence interval = 1.25 - 4.09, p = 0.007).Conclusions: In patients with LV dysfunction, in sinus rhythm, E/(E'×S') is a powerful predictor of new-onset AF.

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