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Published on: July 20, 2022
A new tissue doppler index in predicting future atrial fibrillation in patients with heart failure
Cristian Mornos1, Lucian Petrescu, Dragos Cozma
1Institute of Cardiovascular Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, România. mornoscristi@yahoo.com
Insights
The E/(E'×S') ratio, reflecting left ventricular filling pressure, effectively predicts new-onset atrial fibrillation (AF) in heart failure (HF) patients. This echocardiographic measure offers valuable insights for managing HF and preventing AF complications.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Atrial fibrillation (AF) onset in heart failure (HF) patients often leads to severe cardiovascular complications.
- The E/(E'×S') ratio, derived from mitral inflow and annular velocities, is a recognized indicator of left ventricular filling pressure.
Purpose of the Study:
- To determine if the E/(E'×S') ratio can predict the occurrence of new-onset AF in patients diagnosed with HF.
- Investigate the predictive capability of this echocardiographic parameter in a cohort of HF patients in sinus rhythm.
Main Methods:
- A cohort of 113 hospitalized HF patients in sinus rhythm were analyzed.
- Exclusion criteria included prior AF, poor echocardiographic quality, and other significant cardiac or systemic conditions.
- E/(E'×S') was calculated using average septal and lateral mitral annular velocities; new-onset AF was the primary endpoint.
Main Results:
- During a mean follow-up of 35.7 months, 33 patients (29.2%) developed new-onset AF.
- Patients who developed AF had a significantly higher mean E/(E'×S') ratio (3.09±1.12) compared to those who did not (1.72±1.34; p<0.001).
- A cut-off of 2.2 for E/(E'×S') demonstrated 88% sensitivity and 77% specificity for predicting new-onset AF, with multivariate analysis confirming E/(E'×S') as an independent predictor (HR=2.26, p=0.007).
Conclusions:
- The E/(E'×S') ratio is a valuable and independent predictor of new-onset atrial fibrillation in patients with heart failure.
- This echocardiographic parameter can aid clinicians in risk-stratifying HF patients for AF development.
- Utilizing E/(E'×S') may facilitate proactive management strategies to prevent AF-related complications in HF.
Background:
Onset of atrial fibrillation (AF) in patients with heart failure (HF) is usually associated with a high occurrence of cardiovascular complications. E/(E'×S') ratio (E=early diastolic transmitral velocity, E'=early mitral annular diastolic velocity and S'=systolic mitral annulus velocity) has been shown to reflect left ventricular filling pressure.
Objective:
We investigate whether E/(E'×S') could be a predictor of new-onset AF in patients with HF.
Methods:
We analyzed 113 consecutive hospitalized patients with HF, 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 other patients (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. New-onset AF was higher in patients with E/(E'×S')>2.2 than in patients with E/(E'×S')<2.2 [29 (59.1%) versus 4 (6.2%), p<0.001]. On multivariate Cox analysis including the variables that predicted AF on univariate analysis, E/(E'×S') was the only independent predictor of new-onset AF (hazard ratio=2.26, 95% confidence interval=1.25-4.09, p=0.007).
Conclusion:
In patients with HF, E/(E'×S') seems to be a good predictor of new-onset AF.
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