P388Atrial electromechanical delay is related to functional class and inflammatory status in patients with nonischemic dilated cardiomyopathy

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Objectives: Prolonged atrial electromechanical delay (AEMD) is related to increased risk for atrial fibrillation (AF). The purpose of this study was to evaluate AEMD by tissue Doppler imaging (TDI) echocardiography in patients with dilated cardiomyopathy (DCM) and to investigate whether increased AEMD was related to inflammation and functional capacity.Methods: 51 patients with nonischemic DCM (23 men, 28 women; mean age±SD: 43.9±11) and 39 age-matched healthy controls (14 men, 25 women; mean age ±SD: 42.8±8.3) were included in this study. Left atrial (LA), Right atrial (RA) and interatrial (IA) electromechanical delays (the time intervals from the P wave onset on electrocardiogram to the beginning of late diastolic wave from the lateral, septal mitral and right ventricular tricuspid annulus respectively) were measured with TDI echocardiography. LA volumes were measured according to the biplane area-length method from the apical 4- and 2- chamber views. P-wave dispersion (Pd) was measured by subtracting P minimum from P maksimum in the 12 lead ECG.Results: LAEMD, RAEMD and IAEMD were significantly longer in patients with DCM as compared to controls (23.5±5.7 versus 11.1±2.4 msec for LAEMD, 19.3±8.8 versus 2.8±1.4 msec for RAEMD, 42.9±12.6 versus 14.1±3 msec for IAEMD, p< 0.001). Also, in all subjects, Pd was positively correlated with IAEMD (r=0.95, p<0.001), LAEMD (r=0.70, p<0.001) and RAEMD (r=0.95, p<0.001). Besides in DCM group hs-CRP levels were positively correlated with IAEMD (r=0.79), LAEMD (r=0.60) and RAEMD (r=0.82) (p<0.001 for all). LA volumes were found to be positively correlated with IAEMD, LAEMD, RAEMD, Pd and hs-CRP levels (p<0.001 for all). LAEMD, RAEMD and IAEMD were also significantly longer in patients with NYHA class≥III than patients with NYHA class≤II (25±4.9 versus 22.4±4.3 msec for LAEMD, 20.1±7.6 versus 18.9±8.7 msec for RAEMD, 43.8±12.3 versus 41±11.9 msec for IAEMD, p< 0.001 for all). Although log B-type natriuretic peptide (NT-proBNP) levels were higher in the DCM group as compared to controls (p=0.03), the NT-proBNP levels were not correlated with LAEMD, IAEMD, RAEMD and hs-CRP levels. In patients with DCM, IAEMD, NYHA functional class, Pd and hs-CRP levels were found to be the independent predictors of the PA lateral (p<0.001, p=0.003, p<0.001 and p=0.009 respectively).Conclusion: AEMD was found to be increased in patients with DCM as compared with the age-matched controls. Also, prolonged AEMD is associated with higher functional class and higher inflammatory status.

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